Senior Regional Director, Case Management

Waterbury Hospital Waterbury, CT

Prospect's Mission Statement: "We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve."

Prospect Medical is a family of mission-focused healthcare professionals offering hospital and community-based health services. In partnership with their physicians, their hospitals and affiliated medical groups are committed to high-quality healthcare services tailored to the unique needs of the communities they serve.

Above all, Prospect is committed to quality in all aspects of healthcare delivery, including:

* Striving for the best patient outcomes

* Maintaining the highest standards of patient safety

* Acting with integrity at all times

* Promoting open communication

* Collaborating to better service the healthcare needs of their community

And growing ...


Our Model of Coordinated Regional Care - The Next Generation Healthcare System

Prospect has been growing its business geographically primarily by acquiring health systems and now has 20 hospitals and several inpatient facilities in 6 geographic markets in Southern California (Los Angeles, Orange County and the Inland Empire), Texas, Rhode Island, Connecticut, Pennsylvania and New Jersey. Our growth model is well poised to expand into other geographic markets. As a matter of strategy, Prospect has aligned the acquired hospitals with its employed and affiliated physicians through the development of IPAs in each existing and new market. Now there are developed IPAs in every major market--and IPAs will be developed as a lead component of its Coordinated Regional Care strategy in entering any new markets through hospital acquisition.

All of these activities are designed to move the company farther and faster toward the integrated coordinated regional care system designed to assume and manage both professional and institutional risk from payers. Prospect believes that this is the surest way to secure its place in the post-reform healthcare system.


The Senior Regional Director of Case Management is responsible for implementing the strategy for Case Management as established by the National VP of Utilization Review and Management in collaboration with the Case Management Steering Committee.


The Senior Regional Director is an active participant of the Steering Committee, and is accountable for participating in the development of standard policies, procedures, work flows and data reporting for the PMH system and Southern California market. The Senior Regional Director is accountable for overseeing the execution of Corporate and Local policies and procedures, as well as meeting established performance metrics for Case Management Operations.

Required competencies include:

* Demonstrated knowledge of standard utilization screening tools such as MCG and InterQual.

* Experience and proficiency with Case Management software such as Midas, Cerner or Allscripts Care Manager.

* Knowledge of DRG, Value Based, Risk Based and Per Diem payment methodologies.

* Knowledge and application in State and Federal regulatory requirements pertaining to Case Management and Utilization Review processes.

* Ability to compile, interpret and develop action plans around data and analytics.

* This position requires an executive presence and professional communication skills as well as the ability to function in a matrixed environment.

* The ideal candidate is willing and able to oversee, mentor and develop CM leaders at the Director, Manager and Supervisor level, as well as work collaboratively with Hospital leadership at a facility operations level to address and improve identified issues.

Qualifications – Minimum

* Bachelor's Degree, Master's Degree strongly preferred.

* RN License required.

* Lean Six Sigma Certification or Case Management Certification preferred.

* Minimum of 3 years of experience in Case Management or Utilization Review at the Director Level required.

* Multi facility experience strongly preferred.

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