Director of Care Coordination; DH

Navajo Preference Employment Act

In accordance with Navajo Nation and federal law, TCRHCC has implemented an Affirmative Action Plan pursuant to the Navajo Preference in Employment Act. Pursuant to this Plan and corresponding TCRHCC Policy, applicants who meet the necessary qualifications for this position and (1) are enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe will be given preference in hiring and employment for this position, (2) are legally married to enrolled members of the Navajo Nation, Hopi Tribe, or San Juan Southern Paiute Tribe and meet residency requirements will be given secondary preference, and (3) are enrolled members of other federally-recognized American Indian Tribes will be given tertiary preference.

POSITION SUMMARY

The Director of Care Coordination is responsible for leading, supervising, managing, and coordinating multiple care coordination/social services departments to include Case Management, Utilization Review, Durable Medical Equipment/Transportation, and Purchased Referred Care. The position directs the departments and is fully accountable for monitoring program activities, including compliance, planning, implementing, and evaluating program development to ensure clinical and financial activities promote the continuum of care and appropriate use of clinical and financial resources.

The position is comprised of complex managerial, clinical care coordination and administrative components, associated with critical issues affecting patient care and overall standards of patient care coordination that influence the organizational mission, health care and policy.

The Director of Care Coordination is the clinical and administrative coordinator for all aspects of care coordination including policies and practice, budgetary and administrative oversight of compliance with TCRHCC directives. This position provides oversight for the local Care Coordination department to include: administrative staff for review of eligibility, authorizations and scheduling etc., Social Workers for discharge planning and case management, Registered Nurses (RN's) for case management, utilization review, discharge planning, and processes related to review and approval of Purchased Referred Care referral requests (for justification and medical necessity), and/or denial of Purchased Referred Care referrals and/or cases, and denied/appealed care claims based on eligibility criteria.

The goals are to center services around the patient, to foster patient self-managed care, and maximize efficient and cost-effective use of health care resources. The Director of Care Coordination utilizes all avenues of resources available to ensure staff provide safe and efficient timely coordination of quality health care and services. The role of the Director of Care Coordination is to establish, promote and monitor seamless care for TCRHCC patients.

Education:

Bachelor’s degree in nursing and Master’s Degree in Business Administration or other healthcare related degree.

License:

A valid, current, full and unrestricted Professional Nursing License to practice nursing in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United States

Experience:

Five (5) years of supervisory experience in discharge planning, case management, or utilization review in an acute-care health care setting or related healthcare clinical leadership

Other

Skills and Abilities:

A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers. All employment references must address and indicate success in each one of the following areas:

• Accessing community resources for patient referrals
• Knowledge of diagnosis related groups (DRG) and documentation requirements
• Positive working relationships with others
• Possession of high ethical standards and no history of complaints
• Reliable and dependable; reports to work as scheduled without excessive absences
• Ability to sense varying skill levels and direct instruction accordingly
• Detail oriented, well organized, and applies…