Director Case Management

Overview

Provides leadership, direction, and coordination for the Case Management Department. Accounts for coordinating, developing, executing, monitoring, and evaluating all case management activities. Develops objectives and operational practices that ensure critical success factors involving utilization management and care coordination are achieved.

Responsibilities

1. Assumes responsibility for the oversight of the Case Management department including; clinical resource management, discharge planning activities, and establishing best practice in medical necessity determination and concurrent review activities.

2. Directs the Case Management model that case management services and support at the point of service, with the intent of improving efficiency and effectiveness of the delivery of care (i.e. LOS and cost reduction).

3. Participates in the collection, analysis and reporting of quantitative and qualitative financial and quality data as it relates to utilization management and care coordination activities.

4. Utilizes data to drive decisions and implement performance improvement strategies for the Case Management department.

5. Assures compliance with all regulatory standards regarding required utilization and resource stewardship activities. Collaborates with medical, administrative and clinical staffs to develop systems that improve processes and patient outcomes.

6. Identifies and achieves optimal targeted financial outcomes via the inpatient case management, ED case management, and access case management processes.

7. Serves as a resource person to Patient Financial Services, Revenue Cycle Services, Managed Care, and the Patient Access Center

. 8. Develop and implement department protocols and policies.

9. Participates in the recruitment, development, and retention of high caliber staff members.

10. Collaborates with Case Management Leadership, as well as, with self-directed teams in identifying staff orientation and continuing education needs.

11. Performs employee mid-term and annual performance appraisal/development reviews.

12. Facilitates and organizations the Case Management Meetings to meet continuous education requirements and to communicate strategic organization goals.

13. Actively involved in strategic organization committees that are striving to meet the organizations mission, values, and goals.

14. The authority to hire, separate, promote, demote, write and administer performance evaluations.

15. Other job functions as assigned.

Qualifications

1. RN licensure in the state of Illinois; BSN required; Masters Degree required.

2. Certification in Case Management required (CCM); or willing to obtain within one year of hire

3. Minimum of 5 years progressive hospital and/or case management experience.

4. Working knowledge of Interqual criteria and Midas+.

. Demonstrated knowledge of payer reimbursement methodologies.

6. Results oriented; driver of outcomes; data driven

7. Strong collaboration skills within a multi-disciplinary team.

8. Strong leadership and communication skills directed as eliciting staff and other stakeholder responses and incorporating these where feasible into current processes and related activities.

9. Working knowledge of community resources and/or how to access these systems for appropriate discharge planning modalities.