Director Inpatient Care Coordination and Resource Utilization
Rehabilitation Institute of Chicago

About Shirley Ryan AbilityLab

Shirley Ryan AbilityLab is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions. By joining our team, you will be part of our life-changing Mission and Vision. You'll work in a truly inclusive environment where diversity and equity are championed through words and actions. You'll contribute to an innovative culture that is second to none, one that embraces curiosity, discovery and compassion. You'll play a role in something that's never been done before as we integrate science and clinical care to help patients achieve better, faster outcomes - as we Advance Human Ability, together.

Summary

The Director, IP Care Coordination and Resource Utilization will oversee the care managers assigned to the inpatient units, transitional care and utilization review. The Director ensures that the care managers communicate with the clinical team and third party payers to assess, develop, coordinate, advocate, and monitor a care plan that utilizes the patient's available resources in the most appropriate and cost effective manner. The Director is responsible for ensuring that each care manager coordinates the patient's plan of care, goals and objectives to ensure a smooth transition throughout the continuum. The Director ensures that care managers serve as liaison to patient/family around team communication and coordinate all inpatient discharge needs including equipment, referral to next level of care and reintegration of the patient back into the community.

The Director, IP Care Coordination and Resource Utilization works collaboratively with admitting, medical directors, allied health Directors and nurse managers to lead excellence in patient care and clinical outcomes, while achieving program fiscal targets and adhering to regulatory requirements and best practice objectives. This Director facilitates the utilization review process and the Utilization Review Committee to coordinate effective utilization, evaluation of medical necessity, denial management and appropriateness and efficiency of services.

The Director, IP Care Coordination and Resource Utilization will consistently demonstrate support of the SRAlab statement of Vision, Mission and Core Values by striving for excellence, contributing to the team efforts and showing respect and compassion for patients and their families, fellow employees, and all others with whom there is contact at or in the interest of the institute.

The Director, IP Care Coordination and Resource Utilization will demonstrate SRAlab Core Attributes: Communication, Accountability, Flexibility/Adaptability, Judgment/Problem Solving, Customer Service and SRALAB Values (Hope, Compassion, Discovery, Collaboration, & Commitment to Excellence) while fulfilling job duties.

Principal Responsibilities

The Director, IP Care Coordination and Resource Utilization will:

• Manages and leads SRAlab's team of licensed nurses and social workers in Care Management, Transitional Care and Utilization Review positions. Responsible for scheduling staff to adequately support patient care on the IP units which operate 365 days a year.
• Works collaboratively with the medical directors, AH Directors and the nurse Directors to lead achievement of the clinical, financial, safety, satisfaction, outcomes, compliance and best practice objectives. Drives innovation and commitment to excellence especially in the integration of clinical and research goals.
• Works collaboratively with Inpatient Access/Admitting and Patient Financial Services to facilitate optimum access, appropriate lengths of stay, efficient throughput, concurrent reviews and quality discharge planning to realize organizational fiscal targets and excellent patient care.
• Monitors and reports length of stay, medical necessity and insurance denial. Tracks, analyzes, reports data, trends and identifies best practices and progress toward identified targets and makes recommendations. Provides leadership and direction for resource utilization and length of stay.
• In collaboration with Patient Financial Services, the Director of Managed Care, and the Physicians; seeks payment for denials of inpatient services - Identifies and reviews denials, initiates appeals when indicated, provides denial communication and performs follow up until the case is closed.
• Oversees the inpatient denial of continued stay processes including the Medicare Appeal Process, noncoverage letters and in collaboration with the Director of Managed Care, self-pay agreements.
• Coordinates and facilitates the Utilization Review Committee per the Medical Bylaws - including agenda, minutes, Utilization Review Plan, data gathering and presentation and meeting coordination.
• Maintains knowledge of external requirements for hospital Utilization Review functions including CMS guidelines, federal regulations, state laws, industry standards and best practices.
• Develops, implements and delivers on annual budget targets by initiating cost savings through the efficient management of human/material resources.
• Works collaboratively with SRAlab Outpatient and SRAlab Day Rehabilitation Programs to facilitate referral of appropriate inpatients to these sites of care.
• Ensures effective, efficient and high quality documentation in the electronic medical record of patient care activities to accurately track patient care and to meet/exceed financial and regulatory targets.
• Attracts, develops, mentors, educates and counsels professional staff to meet quality service expectations. Collaborates with SRAlab Human Resources on the implementation of recruitment and retention strategies.
• Initiates and implements quality improvements in individual, program and organizational performance utilizing SRAlabQI and other mechanisms to facilitate resolution of quality issues and/or the promotion of new quality initiatives.
• Drives ongoing evaluation and improvement of clinical protocols and ensures that each staff member has necessary education, training and tools to comply with best practices.
• Offers potential patients/patient families, donors, prospective employees, and other visitors to the organization information and tours of the program areas to facilitate inpatient access or other opportunities which serve the organization.
• Teaches in the SRAlab Academy internal and external courses as well as acts as a consultant at the SRALAB offsite centers and SRAlab Alliances as appropriate.
• Communicates effectively with patients/family members and clinical teams to prevent and resolve conflicts in a timely manner.
• Perform all other duties that may be assigned in the best interest of SRAlab.
• Provides leadership and act a resource throughout the system of care for abuse/neglect situations and appropriate regulatory reporting. Including working with the clinical team, DCFS, Adult Protective Services and law enforcement and attorneys.
• Provide coverage for the hospital in the Administrator on Call role on a rotating basis.
• Coordinate and lead the Complex Discharge Team, in order to coordinate communication and planning around complex discharge planning.
• Coordinate, receive feedback and implement continual process improvement for team conferences. Including CMS regulatory compliance documentation and maintain efficient scheduling and processes for team conferences.
• Represent Care Management and Utilization Review on the Ethics Committee, Patient Experience, and Denial Management teams.