The Director of Case Management plans, organizes, implements, and directs care coordination activities at our Medical Center. He/she is responsible for providing oversight and broad direction to case management, which includes care coordination, utilization review, social services, and discharge planning. The Director of Case Management works closely with the medical staff and the Medical Center leadership to identify patient care trends and issues. The Director develops care management programs, procedures, and clinical pathways that ensure efficient use of medical resources and provide optimum cost effective, quality care.

Qualifications - External

THE DIRECTOR OF CASE MANAGEMENT FULL TIME DAYS CANDIDATE POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.

This position requires proficiency in working with medical statistics and data, including databases. Experience with medical statistical process and control procedures is required. The Director of Case Management must possess excellent written and verbal communication skills and demonstrate the ability to prepare statistical data and report for formal presentations. The Director of Case Management must effectively interact with individuals who possess diverse personalities and levels of professional expertise.

Responsibilities

The individual’s responsibilities include the following activities:

a) manage department operations to assure effective throughput and reimbursement for services provided,

b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,

c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's policy,

d) ensure timely and effective patient transition and planning to support efficient patient throughput,

e) implement and monitor processes to prevent payer disputes,

f) develop and provide physician education and feedback on hospital utilization,

g) participate in management of post-acute provider network,

h) ensure compliance with state and federal regulations and TJC accreditation standards and

i) other duties as assigned.Requirements

Education:

Required: Bachelor's degree in business, Nursing or Health Care Administration for RN or master's in social work for MSW

Preferred: MSN, MBA, MSW, or MHA

Experience:

Minimum Experience: Five to seven years of experience with utilization review, clinical pathways, case management, and disease management are required. Supervisory experience is preferred.

Required: 3 years of acute hospital case management or healthcare leadership experience

Preferred: 5 years of acute hospital case management leadership multi-site experience

Certifications:

Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.

Preferred: Accredited Case Manager (ACM)

Physical Demands:

Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.Benefits