System Director - Care Management

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Central Maine Healthcare is seeking a System Director for their Care Management department! This is a full-time, salaried role with competitive benefits and pay, and a relocation bonus for eligible candidates.

The System Director is responsible for the supervision of the case management manager, Registered Nurse case managers, and Social Work case managers within the hospitals of Central Maine Healthcare. Responsibilities include executing across all areas the strategic vision of Central Maine Healthcare, including planning, directing and coordinating case management initiatives. The principal focus is to achieve high quality, cost-effective care across the continuum of services provided by the organization.

The position requires a balance of evidence-informed clinical knowledge, strong business acumen and effective collaboration at the enterprise, hospital, ambulatory practice and community levels with multi-disciplinary clinicians, administrators, and executives.

• Graduate degree in nursing (preferred), social work or other healthcare related field, including healthcare administration or business administration.
• Five (5) years of progressive management experience in a healthcare facility.
• Experience with management and review of facility admissions, payor authorizations and denials, discharge planning, and Medicare Conditions of Participation.
• Case Management Leadership experience in Acute and/or Critical Access Hospitals.
• Certification by an accredited case management organization such as ACMA or CCMC.

• Translates, executes, delivers, and drives established initiatives set forth by the Clinical, Financial and Operations leaders.
• Acts as a leader and/or liaison to identify and resolve Case Management issues impacting service delivery and escalates to appropriate stakeholders where appropriate.
• In conjunction with the Chief Medical Officer and Associate Chief Nursing Officer, develops policies and standard operating procedures (SOP) and identifies best‑practices for Case Management.
• Responsible for executing and enforcing policies, SOP and best‑practices.
• Prioritizes and implements ongoing performance of new and existing initiatives and develops recommendations/identifies opportunities for performance improvement, including initiatives to address hospital readmissions and ED utilization.
• Directs and coordinates efforts to optimize hospital days, including effective admission determinations, prevention of denials, discharge planning, utilization of ancillary services and timely placement and throughput.
• Ensures compliance with Department of Public Health, Centers for Medicare and Medicaid Services, and The Joint Commission regulations.
• Develops and manages the operational budget for Case Management services and initiatives.
• Ensures the Case Management team performs at the highest level in terms of commitment to the CMH Service Standards, controlling and maintaining departmental expenses, and key performance indicators including quality, safety and patient experience.
• Facilitates the concurrent review of inpatient medical records for accuracy and adequacy of physician documentation.
• Organizes and coordinates the Utilization Review committee for the health system, including preparation of all documents and policies for review and approval.

• Extensive knowledge base and operational skills of clinical practice, care coordination, reimbursement methodologies, discharge planning, utilization management, community resources and related regulations.
• Demonstrated ability to drive organizational accountability, consistent with CMHC expectations.
• Expert ability to translate vision into execution to deliver impactful results.
• Proven record to develop, execute and focus team on value creation.
• Excellent communication and consensus-building skills to align competing agendas across interdepartmental/organizational leadership to drive success.
• Strong analytical, financial and quantitative skills used to guide difficult decision-making, focused on the objectives of the CMHC's strategic plan.
• Strong mediation, political, and negotiation skills to align multiple stakeholders with differing viewpoints.
• Cultural competency, Diplomacy, assertiveness, tolerance for ambiguity.
• Expert level change management abilities to translate vision into execution.
• Demonstrated ability to direct and triage in a highly fluid dynamic operational environment.
• Ability to collaborate with all layers of the management/administration team.

Central Maine Healthcare is an integrated healthcare delivery system serving 400,000 people living in central, western and Midcoast Maine. CMH's hospital facilities include Central Maine Medical Center in Lewiston, Bridgton Hospital and Rumford Hospital. CMH also supports Central Maine Medical Group, a primary and specialty care practice…