Description

Key Job Responsibilities 

Provides overall strategic and operational leadership of the Case Management Department which encompasses the disciplines of Care Coordination, Utilization Management, and Social Work, in both unit-based, payer-based, and team-based models, working collaboratively with faculty, hospitalists and private attending physicians. The Executive Director is accountable for the development and implementation of strategic initiatives, achievement of established metrics, provision of quality services and ensuring optimal performance / productivity of the department as a whole. The Executive Director plays a vital role in optimizing revenue cycle outcomes through the execution of efficient / effective department operations and collaboration with internal and external stakeholders. 

Responsibilities are carried out in alignment with goals, mission, vision, values of Cedars-Sinai, professional practice standards and requirements of regulatory agencies. Scope of responsibility includes Cedars-Sinai Medical Center, Cedars-Sinai Marina Hospital, and may extend to other Cedars-Sinai facilities as the health system evolves.

Primary Duties & Responsibilities

Responsible for planning, organizing, directing, controlling, and evaluating case management services provided in the inpatient/acute facility-based setting across multiple hospitals, with different collective bargaining agreements. Monitors achievement of case management program objectives and implements program changes to improve outcomes.

Establishes and oversees inpatient case management structures to meet different business needs, including floor-based, payer-based and team-based models, with accountability for performance measures associated with each model. Monitors and analyzes department performance against established metrics. Works with department leaders, staff and others to develop performance improvement strategies. Explores best practices and innovative solutions.

Ensures success with value-based care by understanding payer incentive models and divisions of financial responsibility (DOFRs) to establish systems for in-network progression of care and out-of-network inpatient utilization management. Meets regularly with health plans to align on goals and to resolve specific patient care issues. 

Contributes to the development of strategic and operational plans, programs, and policies of Cedars Sinai Medical Center, Cedars-Sinai Marina Hospital, and other affiliates as needed. Develops and implements measurable objectives consistent with the organization’s mission, goals and timelines. Synthesizes information and clearly communicates relevant updates to the department.

Develops and is accountable for department budget performance, personnel practices and overall administration of policies of the Department. Oversees use of outside services funded by the department and other relevant contracts. Monitors staffing patterns, to ensure effective utilization of personnel in relation to patient, departmental and organizational needs.

Optimizes revenue cycle outcomes through the execution of efficient / effective department operations and collaboration with internal and external stakeholders. 
 Promotes the role of Case management, medical social work & utilization management within the organization by effective liaison with directors, physician leaders, and other stakeholders.

Facilitates best practices related to efficient patient flow, transitions of care and appropriate discharge planning for all patients. Ensures identification of Social Determinants of Health (SDOH) through coordinated and deliberate management of a triad Case Management model and works collaboratively across the health system and with community partners to ensure safe discharges and readmission avoidance. 

Provides expertise and direction to hospital case management staff for solving complex clinical and financial patient situations regarding reimbursement issues, social work, discharge planning, utilization review, continuity of care, and systems management.

Collaborates closely with leaders in Ambulatory Case Management, Capacity Command Center, Alternate Sites of Care, and other departments supporting capacity management and transitions of care at Cedars Sinai and its affiliates, to ensure efficient and effective patient care across the continuum.

Uses Leadership principles to build a high performing team, with well-defined expectations, accountability and input. Participates in the planning and development of educational programs for case management staff in alignment with competency requirements. Establishes an environment that encourages professional development and growth. Promotes a positive, safe environment.

Ensures compliance with all applicable local, state and federal regulatory and accreditation requirements including those governing the Case Management department including but not limited to Medicare, Medicaid, and The Joint Commission (TJC). Ensures departmental adherence to all organizational requirements as they may relate to patient safety, quality services and improving the patient experience.

Provides expertise and direction to hospital case management staff for solving complex clinical and financial patient situations regarding reimbursement issues, social work, discharge planning, utilization review, continuity of care/readmission avoidance, and systems management.

Oversees the development and maintenance of Departmental policies and procedures. 

Develops, coordinates and facilitates Departmental goals and objectives in concert with leadership, and in keeping with the annual goals and objectives of Cedars-Sinai.

Remains current with professional standards in the healthcare field, and makes recommendations to change Departmental policy and procedures accordingly.

 Collaborates with inpatient case management leaders across Cedars-Sinai Health System to share best practices and align on common goals and initiatives.

Requirements

Education 

Minimum Requirement - Master's Degree - Public Health or a related field (LCSWs, Case Manager/RNs) 

Preferred Requirement - Doctorate Degree - Public Health or a related field (LCSWs, Case Manager/RNs) 

Work Experience 

Minimum Requirement - 10 years with progressive leadership roles - Case Management experience in an acute care environment in a complex facility

Preferred Requirement - 10 years - Case Management experience in an academic facility

Minimum Requirement - 5 years - Case Management experience in value-based care