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Director of Ambulatory Care Management Services

Company: West Park Hospital-WY-US
Location: Towson
Posted on: September 17, 2020

Job Description:

Director of Ambulatory Care Management Services GBMA Care Coordination

Full Time

Day 8 Hour Shifts (8:30 am-5:00 pm)

40

Req# 34216

Under limited supervision, develops clinical expertise and offers educational programs directed at expanding and enhancing nursing and ancillary staff knowledge and clinical practice related to the care redesign programs and other population health initiatives. Manages a team of nurse care managers and care coordinators to drive the care management work in the system’s PCMH’s. Works collaboratively with providers, practice managers, care managers, care coordinators, behavioral health consultants and all members of the population health team to plan, implement, and evaluate GBMC performance related to the care redesign program expectations and goals. Directs the process of care for ambulatory care management to facilitate quality, cost effective patient outcomes. Provides oversight of care plan documentation and analyzes care management data to refine care redesign workflows and data/reporting systems. Serves as a key resource to all PCMH practices on the behavioral health collaborative care management model. Works collaboratively with internal and external stakeholders. Works with the EPIC team to maximize the efficient use of the EMR.

Education Bachelor’s degree required; Master’s degree in Nursing or Public Health preferred

Experience

A minimum of 5-8 years of related/clinical experience with a Master’s degree; or 8-10 years of related/clinical experience and a Bachelor’s degree; or equivalent work experience. Experience in management role(s) including acute care or ambulatory setting.

Skills

Knowledge of health care, financial, and denial management processes

Knowledge of all aspects of and criteria regarding the health care continuum.

Knowledge of hospital QA/Peer Review processes

Extensive knowledge of all third-party health care reimbursement systems and denial processes

Thorough knowledge of State and Federal Utilization requirements and denial/appeal regulations.

Strong working knowledge of all post-acute services and eligibility requirements; (e.g. Home Health,

LTC, adult day care behavioral health facilities and palliative and hospice care)

Ability to effectively direct others and motivate others to meet or exceed goals and objectives

Ability to build a high performance, collaborative team

Advanced skills in critical thinking and ability to resolve complex problems

Skill in data analysis and reporting

Experienced in effective change management strategies and tools

Ability to effectively execute the organizations strategies for reducing avoidable ED and

Clinical skills necessary to implement and evaluate care plans for patients with multiple comorbidities and complex social determinant of health needs

Knowledge of nursing and adult educational theories in order to assess, plan, implement and evaluate quality educational programs

Interpersonal skills at a level to function well in a wide range of administrative, management and patient care environments

Analytical ability to solve problems and develop goals, objectives, processes, plans, or procedures

Experience using Microsoft Excel

Knowledge of Electronic Medical Record (EMR) functionality and flexibility with using multiple EMRs

Advanced skill in oral and written communication

Licensures, Certifications

Certification in Case Management required within a year of employment

Must possess current Maryland State license as a Registered Nurse

Physical Requirements

Able to perform the physical requirements of the position, which may include activities related to patient care

Ability to travel to multiple practice locations

Working Conditions

Works alternatively in classroom, office or patient care areas with little exposure to excessive noise, dust or temperature

GBMC Values Value Description Respect

I will treat everyone with courtesy. I will foster a healing environment.

Treats others with fairness, kindness, and respect for personal dignity and privacy

Listens and responds appropriately to others’ needs, feelings, and capabilities

I will strive for superior performance in every aspect of my work. I will recognize and celebrate the accomplishments of others.

Meets and/or exceeds customer expectations

Actively pursues learning and self-development

Pays attention to detail; follows through

Accountability

I will be professional in the way I act, look and speak. I will take ownership to solve problems.

Sets a positive, professional example for others

Takes ownership of problems and does what is needed to solve them

Appropriately plans and utilizes required resources for various job duties

Reports to work regularly and on time

Teamwork

I will be engaged and collaborative. I will keep people informed.

Works cooperatively and collaboratively with others for the success of the team

Addresses and resolves conflict in a positive way

Seeks out the ideas of others to reach the best solutions

Acknowledges and celebrates the contribution of others

Ethical Behavior

I will always act with honesty and integrity. I will protect the patient.

Demonstrates honesty, integrity and good judgment

Respects the cultural, psychosocial, and spiritual needs of patients/families/coworkers

Results

I will set goals and measure outcomes that support organizational goals. I will give and accept help to achieve goals.

Embraces change and improvement in the work environment

Continuously seeks to improve the quality of products/services

Displays flexibility in dealing with new situations or obstacles

Achieves results on time by focusing on priorities and manages time efficiently

Principal Duties and Responsibilities

Leadership

Manages the ambulatory care management staff and performs personnel actions such as hiring and orienting new staff, training staff, and conducting performance reviews.

Monitors the workload and productivity of the care management staff to ensure efficient and productive use of time.

Develops, implements, and evaluates care management policies and procedures and develops and educates on standard work.

Communicates priorities with staff and ensures that strategic goals and action plans are being met.

Collaborates with Administrative and Clinical Directors, providers, practice managers, and staff to meet individual and practice needs for improved quality of patient care and cost outcomes.

Population Health

Serves as key resource in the development and implementation of care planning efforts aimed at managing patients with chronic disease, multiple comorbidities, and/or social needs.

Serves as key resource in the implementation of the behavioral health collaborative care management model.

Analyzes and evaluates care management data to make recommendations for workflow refinement. Develops dashboards for use in care management performance monitoring and decision-making.

Drives the design and implementation of EPIC care management modules and reporting tools.

Leads programmatic meetings in support of population health initiatives (i.e., federal and state programs) and serves as key resource in the deployment of population health care management strategies.

Responsible for driving process improvements and quality and cost outcomes measured by the system and federal/state programs.

Assists in program reporting for federal/state care redesign, community benefit and population health initiatives.

Assists with the system-wide integration of care transitions and works closely with the Director of Continuing Care Services to provide quality care throughout the continuum.

Liaise with payers and employer groups on population health/care redesign initiatives as directed and appropriate

Participates in the development of grant applications, as needed.

Is responsible for the development and ongoing operation of the PFAC for the ambulatory practices.

Reviews departments monthly dashboard and collaborates with the care management team, providers, and practice managers regarding the team’s performance and works to improve their performance as appropriate.

Serves on various committees as assigned by the Senior Director of Population Health and/or VP of Continuing Care Services.

Clinical

Oversees clinical assessment and care planning of patients with chronic conditions, high utilization, and complex social needs.

Assists in quality improvement efforts on key population health, primary care quality measures, and behavioral health measures.

Leads the care management team in the implementation of new systems of patient care delivery, including clinical care pathways and behavioral health integration through the collaborative care model.

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Keywords: West Park Hospital-WY-US, Towson , Director of Ambulatory Care Management Services, Other , Towson, Maryland

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