Director, Case Management

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.

• 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

• 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…