Executive Director Case Management
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 6,000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation's leading cancer centers that develops and institutes standards of care for cancer treatment.
Works under the leadership and supervision of the CNO/SVP Patient Services. Designs and implements programs and systems to facilitate transitions of care that meet the department and divisional objectives consistent with City of Hope's philosophy, mission, vision and strategic plan. Directs and supervises the Case Management department. Is accountable for managing service, quality and financial goals for the Case Management operations.
Key Responsibilities include:
This position has the degree of independence required to achieve operating results consistent with approved operating plans, objectives, and policies. The Executive Director (ED) of Case Management is responsible for the overall operation of the Department, including direct interaction with the Medical Staff, compliance with accreditation, title 22 etc. This position must have the ability to influence physician, staff and leadership though the use of effective communication and data driven results. In addition, this position develops and maintains departmental operating budget, annual review and development of case management and utilization plans, is responsible for the hiring and scheduling of staff, annual performance evaluation, coaching, training and providing both verbal and written disciplinary action as required. Moreover, the ED must be familiar with the collective bargaining unions representing the employees. Leads personnel in the provision of safe, high quality patient care, especially as it relates to discharge planning and transitions of care. Works closely with physicians and Advanced Practice Providers to do the same. Responsible for the oversight of authorizations and appropriateness of inpatient admissions, continued stay days, and discharges in a timely manner. Leads teams to achieve strategic outcomes. Collaborates with personnel to assure appropriate and safe staffing/scheduling. Serves as a leader/participant on many hospital committees.
Strategic Program Leadership
- Develop, implement, coordinate, monitor and at least annually evaluate Case Management and Utilization Plans in alignment with enterprise needs and regulatory standards.
- Develop and monitor program budgets for Case Management
- Develop and maintain partnerships with post-acute care partners to ensure that transitions of care can be accomplished in ways that protect our patients and provide the level of care necessary
- Facilitate the ongoing efforts to reduce Length of Stay wherever it is reasonable and safe to do so
- Provide oversight for the safe transition of care for every patient
- Work collaboratively with access, scheduling, revenue cycle and others to ensure methods are in place and functioning to allow for maximized reimbursement and minimized denials and other hazards to payment
Human Resources & Financial Administration
Attract, retain, coach, mentor and counsel registered nurse case managers, LVN's, pre-authorization staff and clerical & data analyst team members to coordinate appropriate utilization review, discharge planning and denial management functions.
- Responsible for the department's daily operations, including achievement of defined goals and objectives through innovative systems and effective departmental policies and procedures.
- Performs annual employee performance evaluation and motivates employees to perform in an efficient and professional manner; recruits and maintain the staff necessary to carry out the functions of the departments.
- Develops revenue growth and effective expense management strategies, inclusive of management of capital and human resources.
Quality & Patient Safety
Lead team members to achieve high quality services and safe care for patients along the continuum.
- Identify and lead performance improvement activities within Case Management services under the direction of the Chief Nursing Officer
- Develops processes that provides effective communication with physicians, leadership and the staff within the dept.
- Develops and implements programs to ensure timely discharge, standardizing processes whenever possible
Basic education, experience and skills required for consideration:
- Master's degree in Nursing
- Minimum of 7 years in nursing leadership
- 10 years nursing experience in Case management
- Experience with Discharge Planning/Utilization Management, Denial Management and related regulatory requirements (CMS Conditions of Participation, Joint Commission) experience required
- Must have Excellent Interpersonal skills
- Self-motivated and directed
- Must be a change agent
- Ability to effectively influence and persuade others
- Irregular hours and on-call (24-hour responsibility)
- California RN license
Preferred education experience and skills:
- CMSA, ACM or CCM certification preferred
- 2-4 years Cancer Center or Oncology experience
City of Hope is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, or status as a qualified individual with disability.
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