Director, Case Management

Med Metrix•Brooklyn, NY

10d•Onsite

About The Position

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.

Requirements

Bachelor’s Degree in Nursing required
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
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 integrity and dependability with a strong sense of urgency and results oriented

Nice To Haves

Master’s Degree in Nursing and other health care related courses preferred
Certification in Hospital Management Strongly Preferred
Certification in Patient Review Instrument (PRI) and Screen
Certification in Case Management

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
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