What are the responsibilities and job description for the Director of Case Management position at Unity Health?
Director of Case Management
Location: Rutherfordton, North Carolina
We are seeking an experienced and dynamic Director of Case Management to oversee the Case Management unit, including clinical resource management, discharge planning activities, patient advocacy, clinical social work, and medical necessity determination. This role is critical to ensuring the effective execution of care management, including adherence to Geometric Length of Stay (GLOS) and the overall success of the Utilization Review Plan.
Key Responsibilities:
- Oversee and manage case management services, including planning, organizing, staffing, and performance improvement activities related to patient care.
- Ensure compliance with policies, regulations, and best practices in care management, discharge planning, and clinical resource management.
- Guide Care Coordination activities in alignment with the organization's needs and requirements, as well as external healthcare systems, regulatory bodies, and affiliated groups.
- Collaborate with physicians, nurses, social services, and other departments to facilitate multi-disciplinary decision-making and improve care outcomes.
- Monitor and ensure appropriate resource use, including medical necessity determinations, and address opportunities to reduce expenses and optimize revenue from admission through discharge.
- Provide education and mentoring to physicians and staff on Case Management standards, ensuring compliance with regulatory agencies such as Joint Commission, OSHA, CMS, and others.
- Lead efforts to optimize care coordination across the care continuum, ensuring that patients' needs are met through all phases of their care.
- Participate in corporate strategic planning, performance improvement programs, and relevant meetings.
- Support the organization's Mission, Core Values, and strategic goals while working towards Performance Improvement Plan (PIP) objectives.
Qualifications:
- Education:
- Associate’s Degree in Nursing required;
- Bachelor’s or Master’s Degree in Nursing or related field preferred.
- Licensure/Certification:
- Current RN license to practice (NC or multi-state compact license).
- BLS required.
- ACMA Certification preferred.
- CCM Certification to be completed within the first year of employment or role transfer.
- Skills & Experience:
- Minimum 3 years of acute care RN or Care Coordination experience.
- At least 3 years of management experience preferred.
- Comprehensive knowledge of care management, discharge planning, Medicare/Medicaid, and commercial insurance review processes.
- Familiarity with Interqual criteria and clinical integration programs.
- Strong communication and interpersonal skills, with an ability to collaborate across multiple teams and departments.
- Ability to work in a fast-paced environment with critical thinking, decision-making, and attention to detail.
Benefits:
- Competitive Medical, Dental, and Vision plans.
- HSA, 401(K) retirement contributions.
- Generous Paid Time Off.
- Accident & Critical Illness Insurance.
- Prescription Assistance through OptumRx.
- Income protection programs for life insurance, Short/Long-term Disability, and Identity Theft.
- Employee Assistance Program (EAP) for emotional, legal, and financial support.
- Travel and entertainment discounts.
Work Environment:
- Ability to work independently with minimal supervision while managing multiple tasks and projects.
- Commitment to creating an environment that encourages professional growth and evidence-based practices.
Join us in making a positive impact on patient care and coordinating essential services for patients across the care continuum. If you're a passionate leader with expertise in Case Management and a commitment to high-quality care, we encourage you to apply.
Job Type: Full-time
Pay: $102,000.00 - $145,000.00 per year
Benefits:
- Dental insurance
- Life insurance
- Relocation assistance
- Retirement plan
- Vision insurance
Supplemental Pay:
- Signing bonus
Experience:
- Director of Case Management: 1 year (Required)
License/Certification:
- Certified Case Manager (Required)
- RN (Required)
- BLS Certification (Required)
Work Location: In person
Salary : $102,000 - $145,000
