Supports the mission of CTCA by treating patients as a whole person in a compassionate and caring environment.
The director leads and orchestrates the development, implementation, supervision and evaluation of all administrative and operational activities of the Care Management department that includes utilization management, care management, social work, clinical insurance appeals, aftercare, precertification and the intake department. Responsible for the development of oncology disease management throughout the continuum of care. Plans and programs to promote best practice and quality of life in the cancer patient. Ensures adherence to all state and federal regulatory requirements dealing with the Care Management department. The director ensures that the care management program results in clinical coordination of care and services for all patients, thereby achieving established targets and goals. The director leads the care management team in the support of CTCA clinical and business needs, including working with physicians, staff, and third party payors to assure optimal documentation, precerts, and reimbursement.This position serves as a critical member of the CTCA team, collaborating and communicating with patients, other members of the management team, care management staff, medical staff, other hospital staff, as well as outside vendors and payors to enhance the quality and efficiency of health care delivery and promote the health and well being of CTCA patients.1. Orients, guides, and oversees the Care Management department.Plans, develops, implements, and evaluates the Aftercare, Care Management, Utilization Management and Intake Department program.Directs and supervises the care management personnel; contributes to the hiring and termination decisions; develops job descriptions, competency and performance standards; ensures compliance with budgetary guidelines. Provides counseling and training, addresses disciplinary problems, and appraises performance. 2. Establishes and maintains an effective and efficient system for disease management, and inpatient care management. Incorporates best practice standards into program development and monitors clinical outcomes of patients served.Develops and maintains an effective system for utilization management that complies with regulatory requirements. 3. Develops policies, procedures and systems that guide and support consistent provision of care and services.Demonstrates awareness of legal issues in all aspects of patient care and unit function and strives to manage situations in a reduced risk manner.Through leadership promotes customer satisfaction. 4. Assures that staff demonstrates the CTCA culture of providing the Mother Standard of care through leading by example and by defining and assuring accountability as appropriateDemonstrates the spirit of Cancer Treatment Centers of America´s values and standards through: Actions and Speech.Connects with customers (patients, caregivers, co-workers) by listening and promoting a mutual understanding. Seeks opportunities for organizational improvement, consistently applies lean thinking principles to departmental operations to enhance or improve service.Communicates pertinent information received from meetings and or memos to department employees in a timely and comprehensive manner.Disseminates new or changing information regarding policies, benefits and regulations to all department personnel via verbal and/or written correspondence.Schedules and conducts monthly departmental meetings for employees to promote intra and interdepartmental operations including monthly updates on key performance indicators.Attends and participates in management meetings.Bachelors Degree in nursing or related field preferred but not required Masters Degree preferredActive Pennsylvania RN license preferred but not required3+ years of experience in a hospital or clinic setting 3+ years of case management experience preferred3+ years management experience requiredExperience building programs such as patient relations strongly desired