System Director of Care Management

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Central Maine Healthcare
January 22, 2021
Lewiston, Maine
Job Type


System Director of Care Management

Case Management
Day shift
Req #: 29165

Position Summary: 

With an enterprise focus, the System Director of Case Management provides leadership, strategic planning, and operations management for Case Management, Utilization Review, Social Work, Connect patient access center, and CAREavan transportation.  This position is responsible for aligning services with the System Director of Post-Acute care, as well as other members of the CMHS patient care team.    

  • Case management services span across the continuum to include but are not limited to: Case management and transitions in care, utilization management (UM), case management, CDI, post-acute providers, nursing services support, social work, and spiritual care services.  The person in this role is responsible to assure the practice of evidence-based case management across the system to achieve outstanding clinical, financial, and functional outcomes. This position has a key responsibility to develop systems which support effective and efficient Case management and interdisciplinary care.
  • This position serves as a resource in regulatory compliance as it relates to patient care services support of quality of care functions and a continuous state of readiness for regulatory site visits.
    Essential Duties:
  • Coordinates and provides clinical administrative leadership for the multidisciplinary clinical teams:
    • Responsible for the design, pilot, implementation, and stabilization of key Case management clinical systems and reports that support Case management, including the enhancement of documentation and reporting systems.
    • Responsible for providing leadership for medical necessity rule interpretation and application
    • Responsible for providing leadership Case Management, Utilization Review, Social Work, Connect patient access center, and CAREavan transportation to assure effective services in support of safe discharges and care transitions.
    • Collaborates with staff of the Accountable Care Organization to support Case management across the continuum.
    • Collaborates with the CMHC Quality Improvement team to support clinical reporting strategies using available data elements.
    • Co-Leads UM Committee to assure physician involvement in decision making and compliance with published regulations.
    • Works collaboratively with CMHC system affiliates to assure alignment with system strategies.
    • Continuously improves service quality by effectively streamlining processes, applying state of the art models to improve customer satisfaction, patient outcomes, and financial performance for the organization to position the organization/system for future care delivery.
  • Responsible for Case management activities:
    • Responsible for leadership, strategic planning, budgeting, evaluation, and team building for all components of case management Department.
    • Assures that standards, triage systems, screens, and staffing are in place for efficient and effective case management and utilization management including case management, discharge planning, social work, and UM activities.
    • Works collaboratively with departments and disciplines on preauthorization, standards of care, patient type, patient placement, and denial management activities.
    • Actively works with billing and medical record systems to assure appropriate coding, documentation, and reimbursement systems.
    • Assures that a structure and system is in place for outcomes management to meet patient needs.
    • Leads the development and evaluation of the annual UM plan and department policies and procedures.
    • Participates in program development to improve case management with services such as the Palliative Care and Accountable Care Organization.
    • Develops innovative strategies for improving unit-based case management and clinical standardization activities.
  • Assures that all regulatory standards are met for areas of responsibility including state, CMS, HIPPA, and The Joint Commission:
    • Participates and/or leads designated committees and teams.
    • Develops quality indicators and outcomes management approaches.
    • Is directly involved in operations, continuously seeking to understand and learn what is done, using various quality improvement tools and processes to monitor and track patient and financial outcomes.

Education and Experience:

  • Bachelor’s Degree in Nursing
  • Master’s Degree in Nursing or health related field (MSN, MHA, MBA)
  • Extensive knowledge base and operational skills of clinical practice, care coordination, reimbursement methodologies, discharge planning, utilization management, community resources and related regulations
  • Strong background and experience in nursing systems to include Case management, Utilization Management, transitions of care.
  • 5 years Care Management Leadership experience in Acute Hospital
  • Current Nursing Licensure in the State of Maine
  • National certification in case management
  • Valid driver’s license when driving any vehicle for work-related reasons.
  • Experience leading Care Management of Critical Access Hospital
  • Clinical Documentation Improvement
  • Patient care regulatory compliance
  • Demonstrated ability to drive organizational accountability, consistent with Health System expectations
  • Expert ability to translate vision into execution to deliver impactful results
  • Proven record to develop, execute and focus team on value creation


Knowledge, Skills and Abilities:

  1. Demonstrated skills in leadership, team facilitation
  2. Excellent interpersonal skills
  3. Quality improvement skills
  4. Excellent communication and consensus-building skills to align competing agendas across inter-departmental/organizational leadership to drive success
  5. Strong analytical, financial and quantitative skills used to guide difficult decision-making, focused on the objectives of the Health System's strategic plan
  6. Strong mediation, political, and negotiation skills to align multiple stakeholders with differing viewpoints
  7. Cultural competency
  8. Diplomacy, assertiveness, tolerance for ambiguity
  9. Expert level change management abilities to translate vision into execution.
  10. Demonstrates the CMHC values and standards of behaviors as well as adheres to policies and procedures and safety guidelines.
  11. Demonstrates ability to meet business needs of department with regular, reliable attendance.
  12. Employee maintains current licenses and/or certifications required for the position.
  13. Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
  14. Completes all annual education and competency requirements within the calendar year.
  15. Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse.  Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
  16. Ability to engage patients and team members utilizing the CMH Experience Standards
      1. I am creating a warming, caring, and non-judgmental environment
      2. I am actively listening and seeking information
      3. I am honest, truthful, and consistent
      4. I am respectful, treating all individuals with dignity and empathy
      5. I am serving as a role model, taking both initiative and ownership when appropriate
      6. I am working collaboratively and demonstrating teamwork
      7. I am resilient and adapt to change in positive ways
  17. Serve as the champion of the patient and team member experience by providing an A+ experience to every patient and team member, every day
Our mission is to provide exceptional healthcare services in a safe and trustful environment through expertise, commitment and compassion of our team members, with the vision of safe, reliable, high quality care for each patient, every day.
How do we make this happen? By creating and maintaining a culture where our values of compassion, integrity, citizenship, service excellence and community are lived out in observable behaviors during all interactions.
Central Maine Healthcare (CMH) is an integrated healthcare delivery system serving 400,000 people living in central, western, and mid-coast 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 organization. Other system services include the Central Maine Heart and Vascular Institute, a regional trauma program, LifeFlight of Maine's southern Maine base, the Central Maine Comprehensive Cancer Center, and other high quality clinical services.
About Central Maine Medical Center
Central Maine Medical Center (CMMC) located in Lewiston, is a Level II Trauma Center serving Androscoggin County and the surrounding region. "CMMC's Centers of Excellence" include the Central Maine Heart and Vascular Institute, the Central Maine Comprehensive Cancer Center, the Neonatal Intermediate Care Unit, and a Trauma Services Program. CMMC is also the southern Maine base for LifeFlight of Maine, the state's only medical helicopter service. Supported by the latest technologies, CMMC's skilled professionals provide outstanding care delivered with compassion, kindness, and understanding. Learn more at:
About Bridgton Hospital
Part of Central Maine Healthcare, Bridgton Hospital serves the town of Bridgton and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. Bridgton Hospital was named as one of 17 top rural hospitals in the nation for the third consecutive year in 2018.
About Rumford Hospital
Part of Central Maine Healthcare, Rumford Hospital serves the town of Rumford and surrounding areas in Maine as part of an integrated regional healthcare system committed to improved access and a uniform standard of care. In 2018, Rumford Hospital was named one of 17 top rural hospitals in the nation by the Leapfrog Group; in 2016, it was designated a Pathway to Excellence® organization by the American Nurses Credentialing Center. Learn more at:
Central Maine Healthcare is equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability status, protected veteran status, or any other characteristic protected by law.
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