Regional Executive Director of Case Management Full Time at AdventHealth

Date Posted: 10/22/2020

Job Snapshot

  • Job Schedule
  • Date Posted:
  • Job ID:
  • Job Family
    Case Management
  • Travel
  • Shift
    1 - Day

Job Description


Regional Executive Director of Case Management

AdventHealth Daytona Beach


Location Address:  301 Memorial Medical Parkway Daytona Beach, FL 32117

Top Reasons to Work at AdventHealth Daytona Beach
  • Career growth and advancement potential
  • High quality of life, low cost of living on the sunny shores of Daytona Beach, Florida
Work Hours/Shift:
  • Full Time 

•         Develops and oversees programs that monitor resource utilization, patient care coordination, clinical document integrity, denial avoidance and optimal patient care transitions for the region.

•         Creates and oversees implementation of organizational strategies across the region to accomplish utilization and length of stay goals, including organizing and facilitating interdepartmental teams, while ensuring efficient coordination of clinical care and appropriate social needs.

•         Provide oversight and facilitates collaborative relationships with CMOs, Physician leaders, Coding, Care Management, Patient Financial Services and other functions to optimize the clinical documentation integrity across the region.

•         Serves as a subject matter expert for Care Management, Transitions of Care and Care Coordination.

•         Consults with the regional and campus Executive Teams regarding Care Management, Social Services, Denial Management, Care Coordination, Transitions of Care, Preferred Provider Network and Clinical Documentation Integrity operations.  Informs and updates local facility CMOs and Executive Teams on issues that impact the strategic goals and objectives of the facility.

•         Exercises primary responsibility for the annual review and approval of the regional Utilization Management Plan by the appropriate medical committee,  administration and the Governing Board, in accordance with the Conditions of Participation from the Centers of Medicare and Medicaid Services, national care management standards of practice and any accreditation standards (The Joint Commission)

•         Responsible for regional oversight and direction for the implementation and sustainment of Care Management Best Practice initiatives and standard work.

•         Provide regional oversight and direction for post- hospital provider appointment program and assure metric goals are obtained.

•         Develop strategy for the expansion of the transition of care program in collaboration with other programs to achieve the metric goal of decreased readmissions.

•         Ensure compliance with all federal and state regulations including, but not limited to Medicare, TJC and licensure requirements

•         Evaluates the department/organization’s compliance with TJC, CMS and other regulatory standards and develops, communicates, and enforces departmental policies and procedures consistent with organizational, governmental and TJC standards.

•         Serves as a transformational leader and develops and monitors strategic plans and implementation for driving care coordination in a manner that is both cost effective and centered on the consumer.

•         Communicates and collaborations, is visible and accessible to leaders, physicians and staff across the region, division and corporate.

•         Oversees campus and regional directors to ensures technical and managerial competence of departmental leadership compliance with organizational values (TWCE) by the leadership team.

•         Demonstrates and leads service management philosophy in departmental and interdepartmental environment.

•         Provides strategic guidance to campus CM Directors for the areas of responsibility for creation and monitoring of financial budgets and targets.

•         Oversees in partnership with CFOs each campus’s department expenditures within budgeted limits as adjusted for facility volumes.

•         Provides strategic direction to campus CM Directors to assure resources are appropriately matched to daily workload and there is monitoring and action plans for labor and productivity variances.

•         Holds campus and regional directors accountable to expectations.

•         Effectively communicates with and influences executive stakeholders.

•         Leads the hiring process for campus CM Directors, Regional Care Coordination Director and Regional Clinical Documentation Integrity Director.  Completes performance evaluations timely and is involved in employee counseling, coaching and termination per policy.  Provides oversight to assure orientation for new employees and ensures compliance with department policy and procedure. Maintains high levels of employee engagement and job performance across the region by overseeing Campus CM Directors to provide recognition and opportunities for learning.

•         Reviews daily correspondence, acts appropriately on requests and information received.

•         Develops and monitors Regional and campus CM and CDI departmental goals and objectives which are consistent with the organization-wide strategic objectives.

•         Supports and monitors programs and initiatives at the corporate level to enable facility or division leadership to successfully meet the program metrics on an ongoing basis.

•         Identifies opportunities and facilitates process standardization, while optimizing technology efficiencies and reporting capabilities in a metric driven environment.

•         Collaborates with Care Management leaders at the Corporate, Division and Campus levels to establish toolkits, education/training, communications and reporting capabilities to support and monitor programs successfully

•         Develops, monitors and participates in identifying opportunities for improvement and Performance Improvement Initiatives.

•         Conducts needs assessment/analyses, identifies gaps, and develops program components to mitigate identified gaps.

•         Aggregates and analyzes data related to Care Management and Care Coordination as required by medical staff, administration, and outside agencies.

•         Creatively and innovatively designs, develops, implements, evaluates and revises case management programs to incorporate current research and evidence based practices, ensuring optimum outcomes.

•         Conducts monthly Staff Meetings for campus and regional directors and managers.

•         Reviews and updates the Utilization Review Plan annually.  Ensures the plan is reviewed and approved by the appropriate hospital committees, state and federal agencies annually.

•         Attends scheduled meetings of the Senior Leadership, Combined Leadership, Nursing Leadership, UR Committee, TJC Taskforce, Managed Care Taskforce, Clinical Best Practice, Revenue Management, CDMP Taskforce, Home Healthcare Advisory Council and other committees or task forces, as required.

•         Represents the North Region in medical staff committee meetings as it relates to care management and social services.

•         Oversees the proactive partnership with external agencies to support and promote the positive image and excellent care coordination of Florida Hospital. (HHC, SNF, DME, PRO, Ancillary Agencies, DCFS, Insurance Reviewers, etc.)

•         Meets with various department, regional and corporate leaders to facilitate a collaborative, cost effective integrated healthcare delivery system.

•         Provides and oversees education for CMOs and Physician Advisors to the UR Plan and responsibilities.

•         Monitors and oversees strategy and actions plans for clinical denials avoidance.  Provide regional oversight and monitoring of campus CMS Quality Improvement Organization (KEPRO) activities including auditing, education and feedback to team departmental and interdepartmental members and physicians.  Escalates issues to Directors, CMOs and CFOs as appropriate.

•         Participates in the organization’s special projects and activities involving community activities.

•         Maintains professional affiliations and enhances professional growth and development to keep up with the latest trends in healthcare.

•         Other duties as assigned.


What You Will Need:

•         Registered Nurse with a Master of Science in Nursing (MSN)

•         Registered Nurse: Minimum of ten years of clinical nursing experience in an acute care hospital.

•         Minimum of five years of leadership experience in the field of Case Management/Utilization Review, and Social Services/Social Work. Department(s) may include but not limited to: Director of Resource Management, Director of Care Coordination, or Director of Case Management and Social Services.

•         Current Florida RN

•         Driver’s license

Job Summary:

Provides regional executive leadership, supervision, direction and support for Care Management, Social Services, Utilization Management, Care Coordination, Transitions of Care, Clinical Documentation Integrity and the Preferred Provider Network.  Provides oversight of these key strategic areas and evaluates the operations for the six hospitals of the Central Florida Division – North Region.   

Provides strategic direction and plans to achieve goals with an evolving healthcare environment including, but not limited to, appropriate length of stay, correct patient placement, reduce avoidable readmissions, provide post-hospital provider appointments, improve the patient experience with transitions of care, denial avoidance, payment model changes and revenue cycle operations.  Works closely with the North Region Chief Clinical Officer in implementing care models as they relate to these key initiatives.  Is responsible for annual budget development, new program development, establishing department policies and procedures, department goals and objectives.   Promotes and coordinates process improvements with other departments to accelerate and drive the outcomes of operational efficiency and clinical excellence.                                                                                                       

Responsibilities include the assurance that the campus leaders and staff adhere to the Florida Hospital – North Region’s Corporate Compliance Program, community- based facilities’ operational policies and procedures; rules and regulations of all local, state, and federal guidelines, and standards of accrediting bodies.  

Ensures principal duties and job responsibilities are achieved through the supervision and direction of the facility Care Management Directors, the Regional Director of Care Coordination and the Regional Director of Clinical Documentation Integrity.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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