Director, Case Management

Directs, plans, implements and evaluates all activities of the case management program. Develops processes to monitor utilization review inclusive of length of stay (LOS) and resource reduction strategies, excess days throughput and industry benchmarks. Capitalizes on facility best practices and makes recommendations for process improvement. Oversees resource utilization for the hospital and provides specific data analysis on utilization to the committee to drive performance. Acts as a liaison to regulatory agencies to ensure compliance of requirements and to ensure third party payers reimbursement/ coverage is approved to meet patients’ level of care. Oversees the coordination of care and transitions of care processes and outcomes across the continuum and provides data and analytics to drive performance improvement in this area.

Job Responsibility

• Leads a functional unit by developing, communicating, and building consensus for goals/programs that supports business unit. Develops and articulates a short-term (6 months – 1 year) strategic vision for areas of responsibility. Directs, plans, implements and evaluates case management of patient care across the continuum of care; collaborates with other hospital directors, establishes goals and objectives for the department. Develops strategies and programs to achieve goals, as evidenced by positive quality clinical and administrative outcomes. Analyzes and evaluates effectiveness of patient care standards, policies and procedures to improve quality of patient care and plans utilization of staff resources and activities aimed at continued quality care. Interprets and implements administrative policies and operational procedures. Develops and implements policies and procedures supporting quality patient driven care through efficient and effective case management. Screens and investigates incidents and patient complaints; determines follow-up needed and initiates corrective action. Performs strategic planning and programmatic development for the case management department. Guides, mentors, motivates and engages the staff in assessing, planning, implementing programs and evaluating patient care as evidenced by patient satisfaction and positive clinical outcomes. Collaborates with physician leadership to develop strategies, formulate plans and implement interventions based on patient needs and clinical resources. Performs related duties as required. All responsibilities noted here are considered essential functions of the job under the Americans with Disabilities Act. Duties not mentioned here, but considered related are not essential functions

Job Qualification

• Master's Degree in Nursing or related field required, or equivalent combination of education and related experience. Bachelors or Masters must be in Nursing.
• Current License to practice as a Registered Professional Nurse in New York State required, plus specialized certifications as needed.
• 8-12 years of relevant experience and 7+ years of leadership / management experience, required.