Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations.
Summary: Ensure that patients receive quality care in the most cost-effective manner and at the appropriate level of care. Manage the operations and activities of the Care Coordination Department including discharge planning, utilization management and high-risk case management. Works collaboratively with the Director of transitions to ensure optimum utilization of Social Work Skills. Responsible for achieving and promoting continuous quality improvement, optimal financial productivity, patient satisfaction and other objectives identified by the Leadership Team. In collaborating with the Executive Director, this position is responsible for staff performance, establishing policies and procedures governing operations of the program and accomplishment of goals in accordance with all State and Federal Guidelines.
Responsibilities: 1. Director Care Coordination- Major Responsibilities Criteria A: Provides direct management to Care Coordination Staff. Ensures staff has education and instruction related to Care Coordination Program. Trains and orients new staff to policies and procedures. Makes hiring and termination decisions in a fair and accountable environment. Develops performance standards. Director Care Coordination- Major Responsibilities Criteria B: Develops program philosophy and operational goals consistent with the Organization’s Mission and Strategic Plan. Ensures program compliance with Joint Commission, State and Federal Regulations relative to Discharge Planning, Utilization Management and Continuum of Care. Director Care Coordination- Major Responsibilities Criteria C: Creates and fosters positive customer relationships with patients, physicians, healthcare agencies and the Network. Supports effective Customer Service Networks in collaboration with the Director of Transition. Identifies opportunities for growth. Develops and implements new services and/or programs. Director Care Coordination- Major Responsibilities Criteria D: Interfaces and coordinates services with Admission, Finance, Managed Care, Medical Records, Home Care, Rehabilitative and Risk Management. Ensures provisions of a seamless continuum of care.
2. Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials. Oversees appeals, at the first level of appeal as appropriate, in an effort to maximize reimbursement. Reviews and edits Managed Care Contract Language relating to Utilization Management Issues. Director Care Coordination- Major Responsibilities Criteria B: Ensures severity of illness and intensity of service criteria evaluations are completed on all patients to achieve efficiency, ensure cost-effective utilization of Hospital Resources and optimize financial performance. Collaborates with UM Medical Director and Vice President of Medicine. Director Care Coordination- Major Responsibilities Criteria C: Develops and monitors Department Budget to achieve efficiency, cost containment and optimal financial performance and productivity Director Care Coordination- Major Responsibilities Criteria D: Fulfills all compliance responsibilities related to the position
3. Director Care Coordination- Major Responsibilities Criteria A: Performs other duties as assigned
4. Fulfills all compliance responsibilities related to the position.
Other information: Required: Bachelor Degree and minimum of five years job-related experience. Master's Degree in Nursing or Health Management desired but not required. Minimum Experience: five years
Desired: Registered Nurse with management experience. Knowledge of community resources, agencies, financial assistance programs/knowledge and/or experience in managed care plans. Excellent communications skills. Ability to collaborate with multidisciplinary groups and staff at all levels including community partners. Problem solving achieves specified goals and assists staff to critically think to reach optimum outcomes. Fosters teamwork and has the ability to integrate the Care Coordination Model and be a change agent. Must possess comprehensive knowledge of the healthcare Industry, familiarity with government regulations and possession of strategic planning skills.
Location: Norwalk-34 Maple St
Work Type: Full-Time
Standard Hours: 40.00
Work Schedule: Day 8
Work Shift: 8a-4:30p
Org Unit: 374
Department: Care Coordination-NH
Education: Essential: * Bachelor's Level Degree
EOE, including disability/vets.
We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business. If you believe you require such assistance to complete this form or to participate in an interview, please contact Human Resources at 203-739-7330 (for reasonable accommodation requests only). Please provide all information requested to assure that you are considered for current or future opportunities.
here some see impossible, we see what’s possible. At Nuvance Health, we continually strive for progress and push past the status quo in all aspects of what we do. We are Nuvance Health!
Our hospitals, medical practices and care centers are located throughout New York’s Hudson Valley and Western Connecticut. At every location, you’ll find:
• Excellent, convenient care: You don’t need to travel to get the care you deserve. At Nuvance Health, we match major medical center standards of care and innovation with the comforts and familiarity of a community health system.
• Personalized approach: We understand each person is unique, and your care should be as well. We take time to get to know you so we can tailor care plans to meet your needs and lifestyle.
• Connected team: You have the full strength of our talented team on your side. Our specialists collaborate to create a customized, comprehensive care plan just for you.
• Access: From Telehealth visits to Urgent Care, our care teams are here when you need us, on your time.