Description

The Case Management Director is the first line manager designated as the leader for Case Management team. the Case Management Director has accountability and responsibility for departmental functions of case management, concurrent coding, utilization review, financial outcomes management, social work, patient education. Plans, coordinates, directs the fiscal, personnel and patient care needs and the age of the patient in as cost effective manner as possible. Collaborates with Quality Management and Nursing Directors in promoting positive clinical outcomes. Responsible for integration of the department into the overall functioning of the organization. Performs other related duties as assigned.

Develops and implements departmental goals, plans, and standards consistent with the clinical,

administrative, legal, and ethical requirements/objectives of the organization.

Directs and evaluates departmental operations, including patient care delivery, information technologies, service level determination, and complaint management, to achieve performance and quality control objectives.

Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions, and continuing education initiatives.

Prepares, monitors, and evaluates departmental budgets, and ensures that the department operates in compliance with allocated funding. Coordinates and directs internal/external audits.

Creates and fosters an environment that encourages professional growth.

Integrates evidence-based practices into operations and clinical protocols.

Provides clinical leadership for the Patient Care Coordinators and Social Worker for day to day issues regarding quality, resource management, utilization review, and discharge planning.

Reviews the delivery of services and care provided in the acute care setting for medical necessity, appropriateness, and conformance to professional standards developed by the Hospital , managed care, and regulatory organizations.

Collaborates with Nursing Director regarding interdisciplinary patient care rounds.

Participates in hospital and departmental safety programs.

Participates in Performance Improvement. Collects data and identifies opportunities for improvement.

Communicates responses to potential or actual payment denials.

Collaborates with individual physicians to resolve utilization review concern.

Qualifications

Minimum Education

Bachelor's degree of nursing required.

Master's degree preferred or an equivalent work experience and education.

North Carolina RN license required.

Required Skills

BLS (Basic Life Support) from AHA (American Heart Association)

Minimum Work Experience

3 years' experience in nursing preferred or equivalent work experience and education.

Previous supervisory experience preferred

Required Skills

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

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