Director of Case Management

Are you a seasoned leader in case management, ready to drive excellence in patient care? We are looking for a dynamic Director of Case Management to join our team and provide administrative leadership across Utilization Review, Integrated Clinical Service, Discharge Planning, and Care Transitions.

Key Responsibilities:

• Administrative Leadership: Oversee Utilization Review, Integrated Clinical Service, Discharge Planning, and Care Transitions, ensuring compliance with Federal/State regulations and private payer guidelines.
• Resource Utilization: Maximize access to and efficient use of resources in a multidisciplinary patient care management program, focusing on patient placement, throughput, length of stay, and timely transitions.
• Committee Leadership: Chair the quarterly Utilization Review Committee, prepare agendas, minutes, and disseminate key reports.
• Stakeholder Communication: Maintain effective communication with patients, families, physicians, payers, and other healthcare entities.
• Patient Rounds: Lead daily interdisciplinary patient rounds and LOS meetings to ensure timely and appropriate patient transitions.
• Claims Management: Possess in-depth knowledge of Medicare, Medicaid, and commercial claims review and denial processes, including appeals preparation and submission.
• Team Leadership: Direct and mentor the case management team, fostering a culture of ownership and accountability.

Qualifications:

• Education: BSN required; Master’s degree preferred.
• Licensure: Current MA licensure required.
• Experience: Minimum of 3-5 years in a Case Management leadership role, with experience in Utilization Review, Discharge Planning, and Integrated Clinical Service.
• Expertise: In-depth knowledge of acute care Case Management, medical necessity criteria, LOS management, readmission reduction, and transitions of care.
• Technical Skills: Proficient in quality, data management, analysis, and reporting.
• Regulatory Knowledge: Current knowledge of State and Federal regulations, Joint Commission standards, HIPAA regulations, and Medicare COP.
• Communication: Excellent oral and written communication, customer service, and organizational skills.
• Leadership: Outstanding leadership skills, including team building, staff mentoring, and relationship building.

Preferred Qualifications:

• Advanced Education: Master’s degree in Health Care Administration, Business Management, Nursing, or related field.
• Team Collaboration: Strong team approach and ability to multitask in a dynamic environment.
• Continuous Improvement: Stay current with best practices impacting clinical outcomes and reimbursement, making recommendations for effective patient transitions.

Join us in this critical role to lead and inspire our Case Management team, driving operational effectiveness and enhancing patient care. Apply today to make a meaningful impact.