Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties. To learn more about Baptist Health, visit us at https://www.baptistfirst.org.
Directs and supervises the provision of clinical care coordination within Baptist Health for all age groups. Directs and supervises the various care coordination functions, including but not limited to utilization review, discharge planning , patient accommodation coordination (Care Logistics) and denials management for Baptist Medical Center South, Crossbridge, Baptist Medical Center East, and Prattville Baptist Hospital. Monitors and manages employee performance and fosters interdepartmental communication and education regarding case management activities and roles. Works collaboratively with the Managers of Care Coordination, Medical Staff and Administration to achieve system and facility targets for LOS and resource utilization while being acutely aware of facilitating optimal patient outcomes and quality of care. Coordinates strategic initiatives for Care Coordination and Case Management in areas related but not limited to re admission rate reduction, daily patient huddles, bed shortage escalation, management of patient admission clearance processes, bundled payment initiatives including post acute care coordination, appropriate use of condition code 44, Physician Advisor program development and program support, Clinical appeals process development, MOON process management, and Observation LOS management. Development of system initiatives for the coordination of Case Management and Care Coordination with Community Case Management and Center for Wellbeing. This position works collaboratively with hospital administration, medical staff leadership, department managers, community providers for both Pre Acute and Post Acute services, ER physicians, Hospitalist, Residency programs, and all applicable providers, to spearhead initiatives, develop training programs, establish tracking indicators, and identify opportunities to improve outcomes related to Care Coordination and Case Management. Description

• Valid AL RN license and Bachelor's Degree in Nursing with 5 years of hospital experience required
• Masters preferred.
• 2-4 years supervisory/managerial experience.
• Previous experience in chart review and data abstraction strongly preferred.
• Previous experience with quality management, licensure/regulatory planning and implementation preferred.
• Certified Professional in Healthcare Quality (CPHQ) required within 12 months in position hire date.
• Proficient in TJC and CMS standards.
• Ability to prepare detailed accurate and factual reports.
• Requires flexibility and ability to redirect priorities as issues are identified as needing immediate attention and or resolution.
• Requires ability to work independently and meet/exceed deadlines, often under stressful situations.
• Must be self-directed and highly motivated with problem solving abilities.
• Knowledge of general statistical analysis and reporting principles.
• Advanced computer skills (Microsoft Office, EMR-Cerner, Qnet, Truven)).
• Performs Root Cause Analysis with Extensive Monitoring Process