Director of Case Management
2 weeks ago
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.
BenefitsBenefits - Full
Relocation Assistance Available - Possible for ideal candidate
Bonus Eligible - No
Overtime Eligible - No
Interview Travel Reimbursed - No
Requirements
Qualifications: Basic Qualifications: Experience Minimum two (2) years of nursing experience required. Minimum two (2) years of experience as charge nurse, preceptor, quality improvement champion or other related leadership experience. Education Graduate of accredited school of nursing. High school diploma OR General Education Diploma (GED) required. License, Certification, Registration Registered Nurse License (California) required at hire Basic Life Support Additional Requirements: ACLS, PALS, NRP certification may be required for positions in specific departments. Evidence of training completion as preceptor or charge nurse. Demonstrated knowledge of quality improvement, clinical care delivery processes, staffing, & budgeting. Knowledge of Nursing Practice Act, The Joint Commission & other federal, state, & local regulatory requirements. Strong interpersonal communication skills. Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications: Bachelors degree in nursing preferred. ACLS certification strongly preferred.
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