Overview

The Director of Case Management (DCM) provides hospital leadership for operations and management of the case management staff and department. Develops and mentors the case management staff and is accountable for evaluating staffing levels and budget management. Will execute, monitor, and evaluate system and facility initiatives. Ensures staff competencies in all areas of case management (utilization review, resource management, and transition/discharge planning, and social work services).

Develop strong relations with hospital senior management, key medical staff, CNO/nursing leadership, HIM/CDI leadership to facilitate quality and efficacious care. Leads hospital and system-wide case management initiatives to meet established benchmarks, standardization, and established targets.

Collaborate with Performance Improvement on CMS clinical indicators to ensure best practice is provided on behalf of our patients. Demonstrates Services Excellence at all times. Other duties as assigned

QUALIFICATIONS:

• Minimum of three to five years managerial experience in an acute health care facility in positions responsible for utilization or case management processes to include discharge planning, electronic referral applications, electronic medical records, clinical care, and previous managed experience required. 8-10 years in case management minimum.
• Experience with Midas and Report Writer functions highly desirable
• Significant experience with InterQual to include use of electronic version, Prefer both hospital and payer case management experience including population management and transitions of care experience. 
• Experienced in use of Microsoft office products. 
• Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines.
• Must demonstrate commitment and adherence to Compliance Program and Code of Conduct through compliance with all policies and procedures, the Code of Conduct, attendance at required training and immediately reporting suspected compliance issue(s) to the Compliance Officer.

EDUCATION / LICENSURE:

• Bachelor's Degree required BS-Master’s degree preferred Registered Nurse and or Master Social Worker Licensed (LMSW) required.
• Must be currently licensed as an LMSW or RN in Texas or holds a compact RN license. CCM Preferred.
• If RN must have and maintain a current BLS certification.