United Health Services System Director Care Management in Johnson City, New York
United Health Services is seeking a full time System Director for Care Management to direct its Care Management program for three hospitals: Binghamton General Hospital, Wilson Medical Center, and Chenango Memorial Hospital. Our Care Management team reviews hospital services on an ongoing basis, evaluates and reports clinical patterns and trends, maintains compliance, and works to improve quality outcomes and ensure patient safety.
The successful System Director for Care Management candidate will join United Health Services’ Quality and Patient Safety Division and report to the VP/Chief Quality Officer.
United Health Services proudly offers competitive compensation and wide-ranging benefits that include health, dental, and vision insurance, tuition assistance, career development opportunities, and paid time off.
Key Responsibilities and Expectations
Develop, implement, and annually review the organization’s Utilization Plan
Operationalize our Care Management Model across all patient care areas, taking into account demographic differences and achieving consistent application of policies and procedures
Identify trends in practices, utilization, or reimbursement that may subject United Health Services to financial risk; work with administration and ancillary departments to develop a plan to reduce or eliminate risks
Identify and ensure educational opportunities for department team members to increase knowledge of care management concepts and trends, streamline activities, and improve patient outcomes
Propose and champion new programs, system processes, and organization-wide initiatives that improve clinical and financial outcomes
Establish and maintain an effective communication/reporting process with medical staff, administration, nursing, and other departments, which will allow them to participate in achieving clinical and financial performance goals
Ensure compliance with business ethics, state and federal regulatory requirements, and organizational policies and procedures among direct report
Maintain all budgetary duties, which includes developing the annual operating budget and identifying capital and salary requirements
Participate in vendor evaluation and identify services not available through United Health Services for consideration
Demonstrate professional judgement in decision making, intervention, and follow through; take responsibility for care management services and ensure resolution for each situation
Develop and maintain collaborative working relationships with other United Health Services disciplines including Access Care, Finance, and Health Information Management in areas related to level of care, insurance coverage, and compliance
Actively promote comprehensive delivery of healthcare across United Health Services and our community and eliminate barriers to effective working relationships among care teams
Bachelor of Science in Nursing (BSN) degree or equivalent healthcare-related science field
Five years of clinical experience including demonstrated effectiveness in coordinating care for a broad range of high-risk and complex patient cases
Master’s degree in a healthcare-related field
Certification in Case Management (CCM)
Experience in acute care, home care, or managed care
Three to five years in a leadership role involving case management, including knowledge of payer mechanism and clinical utilization review criteria
New York State Registered Nurse (RN) license or eligibility