Director of Admissions/Inpatient Care Management
- Job Title
- Director of Admissions/Inpatient Care Management
- Job ID
- 27744756
- Location
- Chicago, IL, 60649
- Other Location
- Description
-
La Rabida Children’s HospitalLa Rabida Children's Hospital is hiring a full-time Director of Admissions/Inpatient Care Management for the Patient Care Administration department in Chicago, IL.
At La Rabida Children’s Hospital, our mission is simple: we’re dedicated to maintaining and improving the quality of life for our patients with complex conditions, disabilities, and chronic illnesses. The path to completing this mission, however, is often complicated. Fortunately, we’ve got the best team around. If you are looking for your next career opportunity to partner with a compassionate multidisciplinary collaborative team, we have the job for you!
Director of Admissions Job Summary:
This position functions as a dual role of Utilization Management, Inpatient Care Management, and Admission Coordinator with the goal of being a clinical liaison between La Rabida Children's Hospital and other pediatric healthcare practitioners, agencies, insurers, and families. The position oversees functions of pre-authorization, utilization review, and quality assurance related to utilization review for compliance with state and federal guidelines as well as serving as a liaison for La Rabida's referral base. This position also reviews the utilization of beds and resources, keeping statistics and recommending appropriate actions to the Utilization Review Committee and medical staff.
Director of Admissions Essential Functions:
Leadership:
-Plans, directs and coordinates operations in support of organizational growth.
-Demonstrates the ability to provide leadership, mentoring, and guidance
-Establishes vision and strategy for the department
-Serves as a change agent, assisting others in understanding the importance, necessity, impact, and process of change
-Promote innovation and foster a child & family-friendly and developmentally focused environment
-Ongoing management and supervision of direct staff
-Ensures quality management activities and service excellence across all areas supervised
-Responsible for annual budget, goals, and performance monitoring for designated staff
-Monitors departments’ operations and compliance with JCAHO and all Federal, State, and Local laws and regulations
-Understands that he/she, and the staff that he/she works with, may be exposed to Protected Health Information (PHI), and ensures that he/she, as well as the staff he/she supervises, treats PHI according to the Hospital’s policies and procedures
Utilization Management:
Knowledge of Healthcare:
-Works with admitting and Case Management staff to ensure that insurance verifications and pre-admission approvals are obtained from third-party payers as needed, including the identified state Peer Review Organization
-Educates physicians and other staff on documentation standards to proactively prevent denials
-Functions as a resource to other hospital departments as a resource on Utilization Review issues.
-Takes action to facilitate discharge or transfer when established criteria for inpatient stays are not met
-Refers cases and issues to the physician advisor for Utilization Review as needed. Follows up on the cases until resolution is reached
-Reviews the hospital Utilization Management program biannually and updates it as needed (in collaboration with the Utilization Review physician and Patient Care Leadership).
-Prepares monthly reports on appropriate utilization statistics (such as length of stay and denials).
Healthcare Business:
-Coordinates all requests for information from external review agencies to facilitate reimbursement
-Serves as hospital liaison/contact for the state-identified Peer Review Organization
-Reviews all charts for completeness before review by the PRO.
-Complete initial and concurrent reviews on open inpatient charts and communicate clinical information to third-party payers for approvals.
-Initiates expedited appeals on denials by coordinating with the health care team to obtain the required information. Coordinates the appeal process related to denial of payments or potential/identified quality of care issues.
-Interacts with health care providers to identify medical necessity and appropriateness of admission to the inpatient setting and provides feedback to staff on appropriate documentation to support the need for admission.
-Works with Patient Financial Services as the clinical liaison to advise and resolve any billing issues
-Provides education to physicians and other staff on topics related to Utilization Review and related standards, such as JCAHO and HCFA
Admission Coordinator:
Communication & Relationship:
-Accepts and responds to assigned referral inquiry calls regarding possible admission within one business day for planned and immediate for all emergency and unplanned referrals. Facilitates communication between the referral source and appropriate clinical staff at La Rabida. Facilitates the timely admission and/or transfer of patients to La Rabida. Acts as a patient advocate in arranging for transfers. Participates in weekly La Rabida Admission meetings
-Provides consultation to referral sources regarding the appropriateness of patients for admission to La Rabida; complex discharge planning issues; and up-to-date information regarding La Rabida services and programs. Attends regularly scheduled rounds at referring hospitals and other agencies as appropriate
-Performs site visits for prescreening assessments as determined by department protocol. Gathers necessary information to determine the appropriateness of admissions based on clinical needs. Meets with families of prospective transfers for transitional care programs to explain the services of La Rabida
-Develop relationships with prospective referral sources. Identifies the needs of the referral source that La Rabida can meet. Identifies possible barriers to referrals and suggests solutions. Works with La Rabida marketing and clinical personnel to identify/evaluate/recommend program enhancements and new opportunities for programs at La Rabida. Participate in outreach activities, including those in the La Rabida marketing plan.
-Provides a plan for introducing La Rabida to families of patients coming to La Rabida, which may include tours and discussions with appropriate members of the healthcare team about expectations.
Quality Improvement & Patient Safety:
-Communicates regularly with referral sources and families regarding the status of referrals. Facilitates communication with referrers on patient status after patients are transferred and periodically during hospitalization.
-Provides regular reports about referral patterns and timeliness of the referral process to the Chief Medical Officer, VP of Patient Care Services, and Senior Management.
-Represents La Rabida in organizations/meetings related to La Rabida's mission and patient population, such as the Consortium for Medically Complex Children.
-Participate in appropriate quality improvement activities
What we need from you:
Education: Graduation from an accredited nursing program
Related Work Experience: Minimum of five (5) years in inpatient nursing, pediatrics, and utilization management required.
Experience in utilization Management required
Licensure/Certification: Current Illinois license as a Registered Nurse
Specialized Knowledge and Skills: Must have knowledge of governmental and accrediting agency requirements and knowledge of managed care (HMO and PPO)
Understanding of Peer Review Organization criteria and standards, including InterQual and Millman Roberts
Must have an understanding of Medicaid regulations and standards related to utilization review
Excellent written and oral communication skills
Ability to prioritize tasks and respond to multiple demands
Effective problem solving
Strong computer skills and knowledge of computer programs (MS Word, Excel, and UR software)
CPR Required: Only certifications issued by the American Heart Association or the American Red Cross will be accepted
What you will receive:- Competitive salary
- Medical, dental, and vision
- Pet insurance
- Flexible Spending Account (FSA)
- Life & disability insurance
- Retirement savings plans & matching
- Tuition reimbursement
- Employee Assistance Program (EAP)
- Generous paid time off & holidays
- Free parking
- Free breakfast and lunch on the last Friday of every month
La Rabida is a place unlike any other. We understand the needs of families with children dealing with the most serious or complicated of conditions with teams of the best healthcare providers in Chicago. We give continuous comprehensive care, education, and support, helping families face their unique obstacles head-on.
La Rabida Children's Hospital is proud to be an equal opportunity employer.
#INDLAR2024
- Required Skills
-
Education: Graduation from an accredited nursing program
Related Work Experience: Minimum of five (5) years in inpatient nursing, pediatrics preferred
Experience in utilization Management required
Licensure/Certification: Current Illinois license as a Registered Nurse
Specialized Knowledge and Skills: Must have knowledge of governmental and accrediting agency requirements and knowledge of managed care (HMO and PPO)
Understanding of Peer Review Organization criteria and standards, including InterQual and Millman Roberts
Must have an understanding of Medicaid regulations and standards related to utilization review
Excellent written and oral communication skills
Ability to prioritize tasks and respond to multiple demands
Effective problem solving
Strong computer skills and knowledge of computer programs (MS Word, Excel, and UR software)
CPR Required: Only certifications issued by the American Heart Association or the American Red Cross will be accepted
