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Senior Director Case Management and Social Work - Penn Presbyterian

Job ID: 208845
Category: Nursing
Work Type: FT
Location: Philadelphia, PA, United States

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Description

Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines.

Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work?

Penn Presbyterian Medical Center (PPMC) in Philadelphia has an outstanding opportunity for an experienced nurse to join the leadership team as a Senior Director to lead the Case Management and Social Work departments.

In this key leadership role reporting directly to the Chief Medical Officer, you will oversee daily and long-term activities and strategies at PPMC with both the Case Management and Social Work departments. You will oversee operational and budgetary functions of these areas to include processes pertaining to Utilization Review, Patient Progression as it relates to Discharge Planning, Appeals Management and partnering with the Physician Advisor in communicating with external payers and internal physicians. You will be accountable for achieving established performance targets through actively engaging multiple disciplines and professional staff.

As the Senior Director, you will lead a team of 60 professionals, developing relationships and optimizing processes to achieve maximum results. You will lead and coordinate multidisciplinary teams and committees supporting clinical process improvement and delivery of quality services, while employing cost-effective measures and ensuring regulatory compliance for continuum of care. You will also maintain and foster relationships with the Business Office and Chief Financial Officer to ensure that processes are followed for reimbursement of all patient days to the extent possible. Budget development and management of the Case Management information systems also falls under your purview. In addition, you will serve as the departmental liaison for the hospital Clinical Effectiveness and Quality Improvement (CEQI) program and initiatives, and you will interact routinely with the other UPHS Entity Directors and the UPHS Office of Managed Care in third party payer issues management efforts.

 

Responsibilities:

· Plans department’s clinical services and operations including review of tracking and trending data to assess the need for performance improvement.

· Translates broad strategies into clear objectives and practical action plans to meet goals.

· Promotes collaboration and removes obstacles to teamwork across the organization.

· Responsible for hospital-wide Discharge Planning efforts to ensure collaboration between Nursing and CRM/SW staff to assure that all patients are discharged efficiently and safely.

· Designs and implements strategies for efficient patient flow, minimizing denied reduced days.

· Partners with Medical Staff and CEQI leadership for the management of Length of Stay and denial reduction efforts.

· Ensures CRM & SW departments maintain continual hospital readiness.

· Utilizes patient-focused, continuous improvement techniques to reach key performance targets.

· Develops and meets department budgets.

· Oversees expense and revenue management including resource utilization for supplies and staff.

· Oversees relationship management with Payers and network providers

· Directs the development of policies, procedures and staffing patterns essential to the day-to-day operation of multiple departments.

· Supports the needs of the physician to provide care for his/her patients in the most clinically appropriate setting by developing and implementing clinical care coordination and outcomes management practices.

· Establishes systems, processes and education that will improve patient satisfaction.

· Oversees and maintains accountability for compliance with all regulatory standards including CMS, the TJC, the DOH and PA licensing requirements as well as organizational quality improvement programs.

· Maintains continuing education to remain current in trends and major advances.

 

Credentials:

  • Registered Nurse - PA (Required)

 

Education or Equivalent Experience:

    • Bachelor of Arts or Science (Required)
    • Master of Arts or Science (Required)
    • Minimum 5 years’ experience in case management/utilization review.
    • Minimum 6 years’ experience in a leadership position.

    We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.

    Live Your Life's Work

    We are an Equal Opportunity and Affirmative Action employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.

       Current UPHS employees must apply HERE
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