Director - Case Management

HonorHealth•Mesa, AZ

3d•Onsite

About The Position

The Case Management Director is accountable for assessment, problem identification, budgeting, outcome monitoring and reporting, long-term planning, and evaluation of operational functions for the Clinical Resource Management and Social Services departments. The role oversees clinical operations for managed care plan contracts, including utilization management, case management, and social services, and directs staff performance and development as well as new processes and improvement efforts. The Director provides leadership for patient-level clinical and financial case management to support high-quality care coordination, transitional planning, and utilization management. The role works closely with the Chief Medical Officer, Case Management Managers/Supervisors, physicians, other system departments, health plans, care facilities, agencies, hospitals, and vendors. It uses data to guide decisions about care delivery, outcomes, productivity, and staffing, and serves as a change agent for new and existing programs. The Director is a member of the Nursing Leadership Council. The position leads department operations, strategic and tactical planning, staffing, budgeting, policy development, quality and cost-effectiveness initiatives, regulatory compliance, and staff education. It supports effective patient movement through the continuum of care, timely discharges, appropriate resource use, patient and family satisfaction, and payor requirements. The Director also monitors financial and utilization performance, reports outcomes to committees and administration, and supports program development and service-line goals.

Requirements

Bachelor's degree in Nursing.
Master's degree in Social Work.
At least 2 years managing a Case Management Department and leading people, projects, or teams in the case management domain.
One of the following required licenses: Registered Nurse (RN), Licensed Master Social Worker (LMSW), or Licensed Clinical Social Worker (LCSW).

Nice To Haves

Master's degree in Nursing or another healthcare profession.
Two years managing a Case Management Department.
Other Accredited Case Manager certification.

Responsibilities

Lead implementation of efficient patient movement through the continuum of care using care coordination, transition planning, and utilization management.
Ensure case management interventions support timely, effective patient discharges, quality care, patient and family satisfaction, and payor requirements.
Prepare, justify, and manage annual operating and capital budgets; monitor expenses, reports, variances, and cost-containment strategies.
Establish staffing patterns and scheduling practices for clinical resource management, social work, clinical documentation, and translation/interpreting services.
Develop relationships with hospital departments and improve support-service utilization and efficiency.
Perform strategic and tactical planning for existing and new programs and services.
Monitor DRG financial performance and collaborate with medical staff leadership to optimize financial outcomes.
Build collaborative partnerships among Case Management disciplines, medical staff, Nursing, system departments, facilities, agencies, health plans, hospitals, and vendors.
Oversee utilization management, social services, and case management for managed care plans, ensuring utilization review complies with plan provisions and applicable regulations.
Develop policies and procedures for Clinical Resource Management and Social Services.
Develop utilization metrics and short- and long-range goals with the Chief Medical Officer and executive staff; monitor implementation and results.
Develop internal processes and improvement plans and evaluate systems for quality, cost-effectiveness, and support of managed-care objectives.
Educate staff on current Medicare and AHCCCS rules and regulations.
Develop strategies to improve patient, physician, employee, and intra-departmental satisfaction and formulate Case Management policies responsive to consumer needs, payor requirements, compliance, and quality of care.
Direct, manage, and evaluate personnel; oversee recruitment, retention, hiring, orientation, competency evaluation, and staff development with Case Management Managers/Supervisors.
Develop annual capital and operating budgets for each facility with Case Management Managers/Supervisors and accept accountability for budget goals.
Serve as clinical liaison for managed care contracts and Medicare and maintain external relationships to support quality service.
Partner with medical staff to support appropriate utilization of resources for hospitalized patients and round with the Chief Medical Officer to identify improvement opportunities.
Report Clinical Resource Management and Social Services outcome indicators to the Utilization Management Committee and Administration.
Support educational opportunities for staff and students, professional relationships, regulatory education, continuing education, quality improvement, and professional organization membership and certification.
Assist in developing, implementing, and monitoring protocols with physicians and other departments.
Use data-based decision-making and facilitate utilization in compliance with state and federal regulations, accreditation requirements, and other legal requirements.
Support service-line initiatives and plan for future program development, space, facilities, and equipment.
Maintain utilization review and discharge planning functions in accordance with accreditation and licensure processes; support the Utilization Review Committee.
Develop, maintain, and evaluate integrated systems that enable Clinical Resource Management and Social Services teams to use InterQual criteria for hospitalized and outpatient cases.
Perform other related duties as assigned or requested.