The Director, Case Management is responsible for overseeing the implementation of the Case Management Program. S/he works in conjunction with executive management to coordinate, monitor and manage clinical, educational and financial systems within the integrated services delivery model. This position maintains and enhances relationships with referral and payor sources.

Work Schedule

Flexible schedules to cover all shifts and weekends, as hospital needs demand.

Primary Duties

Managerial Tasks:

• Identifies, creates and administers process for tracking payor mix, census and patient accounts.
• Assists in the overall operation of the hospital through active participation in projects aimed at achieving the hospitals mission and incorporates the values of the hospital in day-to-day activities.
• Communicates with staff and physicians on administrative issues and follows-up to bring closure to such issues.
• Operates within budgetary parameters.
• Participates with Chief Financial Officer and Business Development staff in census enhancement and maintenance.
• Responsible for adequate numbers of staff on a daily basis.
• Assumes a leadership role in the maintenance of the patient-focused care delivery system.
• Conducts performance reviews of staff in a timely manner per company policy and assists in the development of staff in collaboration with the Education Coordinator.
• Supports the multi-skilled worker environment (i.e., cross training).
• Assists staff in problem-solving and work issues.
• Assists in recruiting and hiring competent staff.
• Responds to issues of harassment and discrimination per company policy.

Communicates with patients, guests, visitors, physicians and co-workers so that:

• Communication, both verbal and written, is clear and accurate.
• Tact, diplomacy, sensitivity and professionalism are consistently demonstrated.
• Appropriate telephone protocol is exhibited.
• Proper channels of communication are adhered to in a courteous and cooperative manner.
• Each patient complaint is acknowledged with the shift and appropriate action is taken.
• Patients and visitors are greeted promptly and made to feel welcome.
• Correct procedure is utilized with hospital information systems and communication with ancillary departments.
• Communication and coordination of multi-disciplinary health team conferences for individual case types are conducted as necessary

Maximizes positive financial outcomes for case types so that:

• Organizational skills and effective time management skills are developed and demonstrated on a daily basis.
• A safe environment for patients, co-workers and visitors is maintained.
• Resource utilization before and after planned change is compared and contrasted.
• Changes/strategies to improve profitability of targeted case types are identified and implemented.
• Assist in assuring accurate documentation to reflect patients clinical status.
• Variances from standard and individualized clinical pathways are monitored and analyzed.
• Efficiency and cost effectiveness of interdepartmental systems are assessed and identified.
• Problems/inefficiencies in interdepartmental operations are identified and communicated to the Vice President, Clinical Services.
• The Vice President, Clinical Services is assisted in planning, implementing and evaluating strategies to correct/improve problems/inefficiencies.
• Performs admission and continued stay review for all payers and levels of care.
• Coordinates with the Performance Improvement Coordinator in appropriate cases to the Medical Director and issues termination of benefits notices with appropriate approval.
• Utilization and quality issues are addressed concurrently and referred appropriately.

Qualifications/Specifications:

• Education: Graduate of an accredited program of nursing and/or degree in Case Management or Social Work required.
• Licensure/Certification: Current state Registered Nurse license or licensure from a state within the Nursing Compact, if applicable. Current Social Work licensure, if applicable.
• Experience: Minimum of three (3) years clinical experience required. Minimum of two (2) years of case management experience preferred.