Overview Childrens Mercy is seeking a Director of Care Management to provide leadership, strategic planning, and oversight of daily operations of the case management department, including utilization management, care progression, and discharge planning. The role promotes interdisciplinary collaboration, service excellence, and consistency in workflows, documentation, quality, and outcomes across the health system. The Director reports to the VP Care Management and is responsible for resource use, financial data reporting, quality and performance improvement, and ensuring compliance and accountability of all functions and services. We are committed to an inclusive workplace that reflects the community we serve and upholds our core values of kindness, curiosity, inclusion, team, and integrity. Note: the seasonal influenza vaccine is a condition of employment for all employees. New employees must be willing to provide vaccination records (MMR, varicella, and/or Tdap as applicable) if non-immune. Medical or religious exemptions can be discussed with Human Resources. Responsibilities Strategic Leadership Develops and implements outcome and in-process metrics for Care Management aligned with the organizations pillars. Directs efforts to achieve goals based on metrics and standard practices for patient status, medical necessity, pre-bill denial avoidance, and denial management. Partners with Revenue Cycle, Payor Relations, HIM, and Risk Management to support utilization management and high-risk patients. Establishes escalation pathways for resolving care coordination barriers across the health system. Leads efforts on length of stay and resource reduction, driving process improvements for efficiency and cost effectiveness. Collaborates with Senior Leadership as a healthcare subject matter expert and facilitates communication between care partners. Builds relationships with payors to align continuum of care and strategies; fosters partnerships with physicians, nursing, payers, patients, and coworkers. Guides interdisciplinary teams using knowledge of hospital processes, clinical care, regulations, and payer requirements to improve patient flow, outcomes, and inpatient efficiency; integrates case management and social work across the system. Ensures case management processes meet or exceed regulatory requirements and oversees project-driven work groups and task forces.

Performance Management and Workforce Engagement Oversees Nurse Case Managers, Social Workers, Utilization Review staff, and support teams. Evaluates operational efficiencies, process design, and organizational structure to enable optimal case and utilization management. Measures efficiency, quality, and cost performance; uses data to drive decisions. Monitors decisioning, appeals, and denials data to coach and recommend improvements. Provides consultation to teams for compliance and leads organizational change to improve processes. Utilizes high reliability and lean principles to evaluate operations and problem-solve. Ensures administrative functions are performed, including performance evaluations and staff development. Recruits, interviews, hires, and on-boards new management staff; collaborates with HR leaders; supports staff development through education and mentoring.

Fiscal and Resource Management Maintains accountability for financial performance of assigned departments and manages the operational budget. Plans, develops, implements, and monitors financial activities; ensures revenue, expenses, and FTEs meet budget; provides forecasts and corrective actions as needed. Ensures resources align to financial goals; participates in negotiating tools and software for utilization review; engages in utilization review committee.

Qualifications Masters Degree (MSN) or Masters Degree in Health Administration and 57 years of management experience in Care Management, Utilization Review, and Performance Improvement Leadership. Licensure : One of the following with MO license upon hire: Licensed RN (MO) or RN Multistate License; or one of the following with KS license upon hire: Licensed RN (KS) or RN Multistate License; RN Compact license for all states besides KS and MO; MO or KS Multistate License required within 60 days of hire. Certification : ACM or CCM required within 3 years of hire. Benefits The benefits plans at Childrens Mercy help support employees and their families. Learn more about Childrens Mercy benefits. Work Location This position is not eligible for remote work; on-site attendance at a Childrens Mercy location is required. #LI-Onsite EEO and Policies Childrens Mercy is an equal opportunity employer. We do not discriminate on 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 on hire. We are smoke- and tobacco-free. We value diverse backgrounds and experiences and encourage all qualified individuals to apply. #J-18808-Ljbffr