Director, Case Management

Job description

Job Purpose

The Director, Case Management is responsible for the administration, direction and evaluation of Case Management services. Develops strategies for the advancement of case management, to include utilization management, coordination of care and transition management. Responsible for projects consistent with the mission, vision, strategic plan, regulatory agencies and clinical needs of the Hospital and Clinical Staff. Critical responsibilities include achievement of annual and periodic goals for significant indicators of performance. The Director, Case Management is responsible to demonstrate, through action and plans, that there is consistent standard of excellence to which all department work is expected to conform.

Duties & Responsibilities

Direct case management and social work activities to monitor quality of care, verify appropriate documentation and compliance with standards

Address and resolve patient/family and staff satisfaction issues on an ongoing basis

Identify and intervene about specific LOS (length of stay) issues on an ongoing basis

Develop and evaluate case management for high risk/high volume patients

Implement and evaluate concurrent utilization review practices

Effectively manages concurrent denials

Utilize data to improve department activities and performance

Collaborate with other department leaders to assure the smooth integration ofCase Management/Social Work services across the continuum

Monitor and maintain JCAHO, federal and state regulatory readiness

Identify and manage clinical revenue enhancement projects

Assist with programs providing learning experiences for staff and affiliating students

Actively participate in the formulation and revision of administrative and departmental case management policies and procedures

Communicate and interpret policy additions/ revisions to staff

Other duties as assigned

Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Understand and comply with Information Security and HIPAA policies and procedures at all times

Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Qualifications

Bachelor’s Degree in Nursing required; Master’s Degree in Nursing and other health care related courses preferred

Minimum of five (5) to ten (10) years acute care clinical experience

Minimum of five (5) years case management leadership experience

New York State Licensed Registered Professional Nurse

Certification in Hospital Management Strongly Preferred

Certification in Patient Review Instrument (PRI) and Screen

Certification in Case Management

Broad knowledge of medical, nursing, and allied health sciences, community resources case management regulatory requirements, and the revenue cycle

PC experience word processing, spreadsheets, and case management/denials software structures

Strong understanding of CMS Conditions of Participation as it relates to utilization management, coordination of care and transition management

Knowledge of HIPAA, privacy, healthcare laws, regulations and standards

Advanced Knowledge in MS Word and Excel

Demonstrated leadership ability required

Ability to apply common sense understanding to carry out instructions furnished in written, oral or diagram form

Ability to deal with problems involving several concrete variables in standardized situations

Strong managerial, leadership, and interpersonal skills

Requires an ability to initiate action, creatively solve problems, meet goals, and produce results through effective supervision of employees

Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses

High level of integrity and dependability with a strong sense of urgency and results oriented

Working Conditions

Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes

Physical Demands:While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Perform light lifting (up to 15 pounds).

Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress

Work Environment:Works in a well-lighted/ventilated office setting. Subject to frequent interruptions. Minimal occupational exposure to infectious diseases, blood borne pathogens, hazardous chemicals, noxious odors, latex, or musculoskeletal injuries. Operate Office machines properly and in accordance with Hospital safety standards. Ability to work in accordance with Hospital Safety Standards.

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

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Who can apply

Review the original listing for work authorization, qualifications and employer requirements.