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Director of Care Coordination

Company: Indian Health Service
Location: Tuba City
Posted on: February 22, 2021

Job Description:

The Indian Health Service continues to work closely with our tribal partners to coordinate a comprehensive public health response to COVID-19. Read the latest info . MAINTENANCE IHS.gov will be offline for approximately 72 hours starting at 4:45 PM ET on Friday, February 12th for planned maintenance. We apologize for any inconvenience. COVID-19 data will continue to be available at https://www.ihs.gov/coronavirus during the maintenance. Summary: With a staff of over 900, TCRHCC is continuously challenged to meet the needs of a growing population, to keep pace with perpetual advances in medical knowledge and technology, and to deal with limited space - very close quarters. We are bursting at the seams and looking toward the future with hopes and dreams of all new facilities, in order to always deliver the best healthcare - the healthcare you deserve!LOCATION AND LIFESTYLE:--- Live and work on the beautiful Navajo Reservation, near national parks and forests, canyon country, ski area a day trip away--- The unique community of Tuba City offers a culturally rich environment and a rewarding career in an underserved area--- Easy drive to Grand Canyon, Lake Powell, Snowbowl ski area, Las Vegas--- Easy access to hiking, biking, fishing, skiing--- Excellent work/life balance--- Very close, collaborative professional staffThe Tuba City Regional Health Care Corporation is located in Northeast Arizona on the land known as the Colorado Plateau. This semi-desert landscape varies in elevation from 4,400 in the Little Colorado River Valley to nearly 7,000 feet at Preston Mesa. The unique community of Tuba City offers a culturally rich environment. The Native American tribes located and served here are the Navajo, Hopi, and Southern Paiute. This mixture along with Anglo, Hispanic, and African American employees of the hospital and school systems make a pleasantly diverse community.Send an email to tcrhcchr@tchealth.org for SALARY RANGE

This position is responsible for leading, supervising, managing, and coordinating the Case Management and Utilization Review departments. Directs both programs and is fully accountable for monitoring program activities, including compliance, planning, implementing, and evaluating program development to ensure clinical and financial activities promote the continuum of care and the appropriate use of clinical resources. Duties: ESSENTIAL FUNCTIONS:1. Supervises the Case Management and Utilization Review staff, including hiring, training, assigning work, counseling, performance evaluation and other personnel/disciplinary actions. Monitors time and attendance for staff; approves leave and overtime hours. Monitors productivity and quality of work performed by all staff. Identifies and implements staffing changes which will measurably increase productivity of department operations.2. Manages the case management and utilization review model to ensure patient care delivery is performed in collaboration and coordination with the organization's resources and multidisciplinary health care team(s) (i.e. Nurses, Physicians, Clinical Case Management, Patient Benefit Coordinators, Patient Registrars, Purchased and Referred Care).3. Administers case management and utilization review programs and service in accordance with Federal laws, regulations, accreditation requirements, policies, procedures, and guidelines; and bases recommends to managers and professional health care providers on costs and benefits of proposed case management actions.4. Ensures Case Management staff develop a care delivery system/service plan based upon the patient's identified needs, available providers, financial resources, family, caretaker(s), and multidisciplinary health care team, which may include other Navajo Area Service areas and/ or other non TCRHCC providers as appropriate.5. Works as a liaison to promote the healthcare of patients and improving care coordination between Case Management, inter-departmental staff, and outside providers. Resolves informal/formal complaints and grievances within jurisdiction and refers appropriately to higher level of management if needed. As appropriate, refers instances of inappropriate patient care, discharge delays, and so on to the Risk Manager and /or Clinical Case Management Division.6. Responsible for initiation, preparation, and oversight of all contracted services for the case management program and represents TCRHCC at inter-agency meetings that may impact case management policy or result in memorandums of agreement to support program initiatives.7. Effectively communicates and coordinates processes to assure the continuity of patient care to outside providers and promote patient advocacy among Navajo Area Indian Health Services/Service Units, and Federal and State entities.8. Develops and implements policies and procedures regarding case management eligibility, alternate resource programs, referral/notification process, interdepartmental relationship and responsibilities; promote patient access to the appropriate level of care, prevent over or under utilization of resources, maximize the use of alternate resources, and supports continuity of care. Responsible for review, research, and decision of first level appeal process.9. Leads education activities to enhance the quality and completeness of clinical documentation, and patient care coordination. Makes certain training/continuing education is available for staff as appropriate either on-site or external training to improve skills in data entry of all Case Management Services referrals.10. Ensures Utilization Review staff conducts timely follow-up reviews of clinical documentation from pre-admission to post-discharge, continued stay, cost containment and discharge planning, and issues are discussed and clarified with the physician, and recorded in the patient's chart.11. Ensures Utilization Review staff collaborates with the House Supervisor and the accepting physician regarding the appropriateness of the transfer of patients from discharging outside facilities to TCRHCC or return back to TCRHCC.12. Educates and oversees the Utilization Review nurses in modifications to clinical documentation to ensure that appropriate reimbursement is received for the level of services rendered to all patients with a DRG-based payer. Ensures timely submission of inpatients admissions for Third Party Payors (TPA).13. Identifies utilization trends such as avoidable days, hospital acquired conditions, and denials of authorization and report these trends to appropriate Senior Leaders, committees, and staff to promote education and change within the facility.14. Provides clinical expertise, skills, and behaviors appropriate to the population(s), served, and based on specific criteria and/or age-specific considerations. Supports, educates, and oversees the overall quality and completeness of clinical documentation by performing admission/continued stay reviews using clinical documentation enhancement guidelines for selected patient populations.15. Leads and facilitates the Utilization Review Committee, develops and interprets reports (i.e. statistical, financial, trends), provides data for the PI Committee and submits reports, as required, on outcomes, clinical quality documentation and insurance medical necessity criteria.16. Completes all patient care documentation in the electronic health record entries accurately and in real-time.17. Participates in departmental workflow and or testing teams as related to electronic health record or other project initiatives18. Performs other assigned duties as needed. Qualifications: Education:Bachelor's degree in Nursing or healthcare related fieldEducation:A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United StatesExperience:Three (3) years of supervisory experience in discharge planning, case management, or utilization review in an acute-care health care settingOther Skills and Abilities:A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:- Accessing community resources for patient referrals- Knowledge of diagnosis related groups (DRG) and documentation requirements- Positive working relationships with others- Possession of high ethical standards and no history of complaints- Reliable and dependable; reports to work as scheduled without excessive absences- Ability to sense varying skill levels and direct instruction accordingly- Detail oriented, well organized, and applies critical thinking, reasoning, deduction, and inference skills- Knowledge of report writing, graphical analysis, and working with computer spreadsheets and database programs Please use the following information to get more information about or apply for this job posting. IHS Headquarters, Indian Health Service, 5600 Fishers Lane, Rockville, MD 20857 - Find a Mail Stop

Keywords: Indian Health Service, Saint George , Director of Care Coordination, Executive , Tuba City, Utah

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