Director of Care Management

Do you envision finding a meaningful role with an inclusive and compassionate team? At Children's Mercy, we believe in making a difference in the lives of all children and shining a light of hope to the patients and families we serve. Our employees make the difference, which is why we have been recognized by U.S. News & World Report as a top pediatric hospital, for eleven consecutive years.

Children's Mercy is in the heart of Kansas City - a metro abounding in cultural experiences, vibrant communities and thriving businesses. This is where our patients and families live, work and play. This is a community that has embraced our hospital and we strive to say thanks by giving back. As a leader in children's health, we engage in meaningful programs and partnerships throughout the region so that we can improve the lives of children beyond the walls of our hospital.

The Director of Care Management responsible for providing leadership, strategic planning, and oversight of daily operations of the case management department which includes utilization management, care progression and discharge planing promoting interdisciplinary collaboration, teamwork, and championing service excellence. The Director of Care Management works under the strategic direction of the Senior Director of Care Management and responsibilities include appropriate and effective use of the department resources, oversight of collection, analysis and reporting of financial data, quality improvement and performance improvement and ensuring compliance and accountability of all functions and services. The position will ensure consistency in workflows, documentation, quality and outcomes for case management across the health system.

At Children's Mercy, we are committed to ensuring that everyone feels welcomed within our walls. A successful candidate for this position will join us as we strive to create a workplace that reflects the community we serve, as well as our core values of kindness, curiosity, inclusion, team and integrity.

Additionally, it's important to us that we remain transparent with all potential job candidates. Because we value the safety of the patients and families we serve, as well as the Children's Mercy staff, we want to let you know that the seasonal influenza vaccine is a condition of employment for all employees in our organization. New employees must be willing to be vaccinated if found non-immune to measles, mumps, rubella (MMR) and chicken pox (varicella) and/or without evidence of tetanus, diphtheria, acellular pertussis (Tdap) vaccination since 2005. If you are selected for this position, you will be asked to supply your immunization records as proof of vaccination. If you and have any concerns about receiving these vaccines, medical and/or religious exemptions can be further discussed with Human Resources.

Strategic Leadership

Develops and implements outcome and in-process metrics for Care Management aligned with the organization's true North pillars.
• Provides direction to achieve the goals and objectives based on metrics
• Develops and implements standard practices that represent best practice in patient status recommendations, medical necessity review, pre-bill denial avoidance and denial management.
• Partners with Revenue Cycle, Payor Relations, HIM and Risk Mangement in support of utilization management and high-risk patients
• Creates accountability and escalation pathways for resolving care coordination and care progression barriers throughout the health system.
• Accountable and responsible for length of stay and resource reduction strategies making recommendations for process improvement to maximize efficiency and cost effectiveness
• Contributes as a partner with Senior Leadership as healthcare subject matter expert.
• Acts as liaison to facilitate communication and collaboration between all care partners (internal and external partners, etc.)
• Establishes relationships with payors to promote continuum of care alignment and strategies.
• Facilitates development of trusting relationships and partnerships with physicians, nursing, payers, patients, and coworkers.
• Utilizes knowledge of hospital processes, clinical patient care, state and federal regulations and payer requirements to participate and guide leadership of interdisciplinary teams towards improvement of patient flow and patient progression, clinical outcomes and efficiency of inpatient stays. Continually strives to integrate case management and social work across the system.
• Ensures that all case management processes and outcomes meet or exceed regulatory requirements.
• Directs and oversees the activities of all work groups and task forces that are structured to drive projects and improvements for case management.

Performance Management and Workforce Engagement

• Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization Review specialist team members and support staff
• Analyzes, evaluates, and recommends operational efficiencies, process design and organizational structure that enables optimal case management and utilization management.
• Objectively measures efficiencies, productivity, quality, and cost performance to identify and track performance, and use data to drive decisions.
• Monitors and evaluates decisioning making by tracking and assessing overturned appeals, physician decision trends related to level of care and status, and denials data to coach to and make recommendations for improvement
• Provides consultations/direction to individuals and /or teams or committees to facilitate compliance.
• Serves as catalyst for organization change to improve operational and clinical process that impede patient progression toward optimal outcomes.
• Utilizes high reliability principles and the lean operating system and tools to evaluate operations and problem solve.
• Assures that departmental administrative functions are performed, including team member performance evaluations and development.
• Recruits interviews, hires and on-boards new management staff. Provides direction and evaluates departmental workload and responsibilities. Collaborates effectively with Human Resource leaders.
• Provides support and guidance to enhance staff and management development by providing education, training, coaching, role modeling and mentoring.

Fiscal and Resource Management

• Maintains accountability for meeting established financial performance metrics for assigned departments.
• Works collaboratively with department leadership team to plan, develop, implement, and monitor all financial activities of the department.
• Responsible for approving and managing the day-to-day dept. operational budget. Assures that revenue, expenses, and FTE's meet or exceed budget; prepares and submits budget and related reports; forecasts and accurately projects expenses; takes corrective action to address negative variances; identifies and proposes capital budget items appropriately.
• Identifies and ensures appropriate resources to achieve department financial goals.
• Participates in negotiations regarding adding or renewing medical necessity critical decision support tools and related software applications and implementations.
• Engages in utilization review committee.

• Master's Degree MSN or Masters Degree in Health Administration
  • and 5-7 years experience
    • experience in Management, Care Management, Utilization Review, and Performance Improvement Leadership
• One of the following: Licensed RN - MO, Registered Nurse Multistate License Missouri required upon hire
• One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas required upon hire
• RN Compact license for all states besides KS and MO
  • Licensed RN - MO or KS Multistate License required within 60 days of hire
• ACM or CCM required within 3 years of hire

The benefits plans at Children's Mercy are one of many reasons we are recognized as one of the best places to work in Kansas City. Our plans are designed to meet the changing needs of our employees and their families.

This position is not eligible to work remotely, which means that the person hired will be required to work onsite at one of our Children's Mercy locations and may not work from home.

Children's Mercy hires individuals based on their job skills, expertise and ability to maintain professional relationships with fellow employees, patients, parents and visitors. A personal interview, formal education and training, previous work experience, references and a criminal background investigation all are factors used to select the best candidates. The hospital does not discriminate against prospective or current employees based on the race, color, religion, sex, national origin, age, disability, creed, genetic information, sexual orientation, gender identity or expression, ancestry or veteran status. A drug screen will be performed upon hire. Children's Mercy is smoke and tobacco free.

CM is committed to creating a diverse and inclusive workforce. Our patients and families come from all walks of life, and so do we. We know that our greatest strengths come from the people who make up our team so we hire great people from a wide variety of backgrounds, not just because it's the right thing to do, but because it makes our hospital stronger and our patient care more compassionate.

If you share our values and our enthusiasm for service, you will find a home at CM. In recruiting for our team, we welcome the unique contributions that you can bring, including education, ideas, culture, ethnicity, race, sex, sexual orientation, gender identity and expression, national origin, age, languages spoken, veteran status, color, religion, disability and beliefs.