Description

Work where every moment matters.

Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

Hartford HealthCare (HHC), with a total operating revenue of $5B, leverages its unified culture to enhance access, affordability, equity and expertise. Its care-delivery system, with more than 400 locations serving 185 towns and cities, includes two tertiary-level teaching hospitals, an acute-care community teaching hospital, an acute-care hospital and trauma center, three community hospitals, the state's most extensive behavioral health network, a large multispecialty physician group, a clinical care organization, a regional home care system, Connecticut's largest array of senior care services, and a comprehensive physical therapy and rehabilitation network. On average, Hartford HealthCare touches more than 17,000 lives every single day. The unique, system-wide Institute Model offers a unified high standard of care in crucial specialties at hospital and ambulatory sites across Connecticut. The Institutes include Cancer, Heart and Vascular, Ayer Neuroscience, Orthopedics and Tallwood Urology.

Position Summary:

The System Director of Clinical Resource Management, being an integral member of the HHC Care Management Executive Leadership Team, will develop, direct and monitor the utilization management functions for HHC ensuring that the resources expended to care for our patients are appropriate to the clinical needs of the patient and are being delivered in the least invasive, least restrictive and least costly environment. The System Director ensures the highest quality patient care while maintaining fiscal stewardship for HHC as well as regulatory compliance.

Key Accountabilities:

• Provide day to day oversight of utilization management operations across the system including budget, staffing, recruitment, performance management, training and special projects
• Determine policies and procedures for the performance and optimization of utilization review functions incorporating best practice and ensuring system wide compliance with contractual, regulatory and accreditation entities
• Establish and monitor performance indicators, goals and objectives that are consistent with Revenue Cycle and HHC strategic objectives, mission, vision and values
• Ensure monitoring and tracking tools are in place to adequately link and assess staff production and performance
• Develop and maintain management reports which show progress to goal, overall performance, as well as patterns, trends and emerging issues
• Develop, oversee and facilitate a system wide Utilization Management Plan, including a Utilization Management Committee, which meets regulatory compliance standards and evaluate annually
• In collaboration with Physician Advisor resources, ensure adequate and appropriate education to physicians regarding relevant resource utilization standards and trends
• Develop and maintain communication channels with Revenue Cycle and all departments therein to promote synergy with utilization management functions
• Maintain awareness and understanding of value-based payer opportunities and incorporate into utilization review strategy and focus areas, attend payer Joint Operating Committee Meetings
• Ensure compliance with joint venture care model components specific to utilization review

Qualifications

• Bachelor's Degree in Nursing or other healthcare related field is required. Master's Degree in Nursing, Business Administration, Healthcare Administration or related field is preferred
• Five plus years of Utilization Management/Utilization Review experience
• Three plus years of leadership experience
• Current license in good standing to practice as a Registered Nurse in the State of Connecticut
• Process redesign and change management
• Able to influence and negotiate
• Executive presentation and excellent interpersonal communication skills, relates well with all levels of the organization
• Ability to understand and interpret patient data, finance and utilization reports
• Highly effective analytical, organizational and problem-solving skills
• A creative, forward thinking leader with the proven ability to engage, coach and mentor direct reports, colleagues and other key stakeholders
• Knowledge of Interqual or equivalent criteria and reimbursement guidelines
• CCM (Certified Case Manager) or other applicable certification is preferred

We take great care of careers.

With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge - helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.