Category Management Facility Aspirus Wausau Hospital Inc
Physical Work Location Wausau, WI Department Aspirus Wausau Hospital Inc - Care Coordination Schedule Full Time Shift Day Req# 18361 Job Details Bachelor’s Degree
The Director of Care Coordination is responsible for the operational oversight of Care Coordination which includes the following functions: utilization management/case management and inpatient and outpatient Social Work. The position is accountable for ensuring efficient and effective care transition for patients and families across the care continuum. Works collaboratively and in partnership with patient care leaders in all settings. Facilitates organizational compliance with applicable regulatory, licensing, accreditation standards, and provides leadership within the interdisciplinary team to achieve desired clinical, financial, compliance, and resource outcomes.
Knowledge of patient care standards and management practices in a healthcare environment normally acquired through completion of a Bachelor’s Degree in Nursing or related clinical field. Master’s Degree preferred.
Mandatory knowledge of federal, state, and accreditation guidelines plus financial principles, reimbursement methodologies (PPS, APCs), coverage issues, coding conventions, and insurance/managed care practices.
A minimum of five years’ experience in an acute care setting with three to five years supervisory/administrative experience and five years’ experience in utilization management, case management, or quality improvement required.
Pertinent experience, track record, and training in medical management philosophy and practices.
Possesses an active Wisconsin RN nursing license or current Social Worker license.
Nationally recognized certification preferred, i.e., Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), Certified Professional Utilization Review (CPUR), or Diplomat of American Board of Quality Assurance and Utilization Review Physicians (D-ABQAURP).
Knowledge of HEDIS, PQRI, Core Measures, NCQA.
Possesses working knowledge of clinical systems, outcome measures, and processes required along with various patient information systems including Pathways, HEDIS, etc.
Knowledge and understanding of hospital information systems and their potential uses and benefits.
Possesses facility for data analysis and interpretation. Must be data driven with a passion for medical management. Possesses ability to organize and present data in a concise and easily understood manner to peers, physicians, and other stakeholders.
Location/Region: Wausau, WI (US)