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. Such standards are based on establishing and maintaining a consistency of purpose, focusing on continuous improvement within the Director’s area of influence, and delivering the highest degree of quality service possible.

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 of Case 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
• Performs other related 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
• 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 and privacy regulations
• Knowledge of 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 
• Excellent written and verbal communication skills required
• Gracious and welcoming personality for customer service interaction

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.