Director of Case Management

Orlando Health-posted about 1 year ago
Full-time • Director
Sebastian, FL
Ambulatory Health Care Services
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The Director of Case Management is responsible for the leadership and oversight of Care Management departments at Orlando Health, focusing on care coordination and utilization review. This role involves strategic planning, implementation, and evaluation of programs to ensure quality patient care and compliance with regulatory standards. The director will lead teams, manage budgets, and foster collaboration across departments to optimize patient outcomes and support continuous improvement initiatives.

  • Demonstrates leadership and management skills from front-line staff supervision to strategic leadership; leads the Managers, Care Management.
  • Provides leadership and strategic direction for day-to-day operations for all assigned departments/programs to include process improvement projects, as needed.
  • Demonstrates extensive knowledge in reimbursement methodology.
  • Ensures highly effective collaboration for all Care Management departments such as Care Coordination, utilization review and Mental Health Therapy/Counseling services to optimize best care opportunities for patients and families served.
  • Promotes and supports regular education and training programs that continuously strive toward best clinical outcomes and overall performance improvement.
  • Collaborative responsibility for the development, analysis, and accountability of department budget.
  • Measures actual budgetary performance (revenue, expense, staffing) against standards, and ensures variances are within established targets.
  • Provides direct support and assistance to the managers and staff members assigned for the full accomplishments of their assigned duties and responsibilities.
  • Monitors, evaluates, and redesigns departmental guidelines relative as it relates to the roles and responsibilities of assigned teams and ensures compliance to meet or exceed all regulatory and accrediting agency requirements.
  • Understands the regulatory and external review agencies, third party payers, and community-based organizations.
  • Demonstrates knowledge and skill in data preparation, analysis, and presentation to maintain effective, efficient, and compliant work environments.
  • Creates data priorities and establishes dashboards for monitoring outcomes.
  • Ensures provision of quality services by maintaining appropriate staffing resources, staffing levels, competency of staff, and ongoing training and education.
  • Develops structures and processes that contribute to continuity of care through demonstrated use of the interdisciplinary team approach to patient care.
  • Establishes and maintains an open and positive working relationship with board members, physicians, managers, employees, patients, visitors, and the community.
  • Develops/implements personal goals/objectives that support the organization's strategic/operating plans and patient care services.
  • Develops and implements operational plans for the hospital in conjunction and consistent with the overall Orlando Health strategic goals. Establishes system for control of variances.
  • Participates with leaders from the governing body, management, medical staff, and clinical areas in hospital's decision-making structure and process.
  • Recruits, develops, retains, and evaluates qualified managers and staff members, recognizing the full accomplishments of staff assigned duties and responsibilities.
  • Works collaboratively with internal and external departments and agencies, physicians, and all members of the interdisciplinary team in meeting customer needs and organizational goals.
  • Acts as liaison to external accrediting/regulatory bodies for health plans on issue related to care coordination.
  • Ensures technology and software systems support workflow with clinical logic, standards of practice, and regulatory accreditation requirements.
  • Participates in or chairs appropriate councils, committees, activities, and special projects as needed.
  • Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards.
  • Ensures a method to monitor customer satisfaction with respect to services delivered, utilizing corporate and/or unit specific tools.
  • Speaks on behalf of care management services in established meetings of hospital leadership, medical staff, and governing bodies.
  • Supports all policies, procedures, goals, and objectives and maintains compliance with all Orlando Health policies and procedures.
  • Bachelor of Science in Nursing (BSN), or a Master's in Social Work (MSW), Mental Health Counseling, or Marriage and Family Therapy, or a Graduate degree in Business or health-related field (Nursing, Business Administration, Health Administration).
  • Maintains current State of Florida Registered Nurse (RN) license or Nurse Licensure Compact (NLC), or maintains Florida State (Chapter 491 Florida Statutes) licensure as a Licensed Clinical Social Worker, Licensed Mental Health Counselor/Therapist.
  • Three (3) years of experience in chronic disease management, care management, care coordination, utilization management, or acute clinical care including Care Management leadership is required.
  • Experience in managing care management services, including productivity enhancement, cost reduction, new program development, and quality management is also required.
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