Director, Care Management RN

About the role

Oversees the departments recruitment and retention activities, taking action to ensure adequate staff and leadership in care management.

Actively engages with post-acute care entities to improve patient care transitions and decrease readmissions.

Leverages and leads technology change management to improve staff efficiencies, drive positive patient outcomes, and maximize the tools care managers utilize to perform their roles.

Directs daily operations of the care management department, including discharge planning, care coordination, progression of care, and social services.

Ensures compliance with CMS CoPs for Discharge Planning as well as related federal and state regulations.

Participates in Corporate Care Management meetings, cascades information, and implements strategies with standard work and processes.

Develops and oversees the implementation and compliance with Care Management policies and standard operating procedures.

Collaborates with interdisciplinary hospital leaders and executives to achieve organizational goals.

Develops and meets operational budget performance with oversight to assure capital and fiscal accountability.

Partners with Utilization Management for the Utilization Review Committee as well as day-to-day operations.

Identifies improvement opportunities and develops, implements, and monitors action plans.

Educates and mentors facility Care Management staff and the interdisciplinary teams on data, outcomes, and opportunities.

Responsibilities

• Understands medical necessity for appropriate patient status and level of care
• Understands Care Management best practices
• Researches and reasons best practices to support process improvement
• Strong verbal and electronic communication skills
• Analyzes, evaluates, and monitors data in addition to providing action plans
• Sustains goals of Care Management metrics, voice of the customer experience, employee engagement, and quality outcome viability of a Care Management program
• Supports positive employee relations and customer experience
• Understands Microsoft Office Products and other appropriate software platforms
• Understands CMS Conditions of Participation for Discharge Planning
• Understands Managed Care and Value Based Programs
• Works autonomously with self-direction
• Collaborates with a diverse leadership team
• Leads and sustains change
• Knowledge of change management principles, methodologies, and tools

Requirements

• Bachelor's in Nursing
• Master's in Nursing (preferred)
• 5+ direct care management experience
• 3+ care management leadership experience
• 2+ frontline nursing experience
• Registered Nurse (RN) license
• Accredited Case Manager (ACM) certification (preferred)
• Certified Case Manager (CCM) certification (preferred)

Skills

• Understanding of medical necessity for appropriate patient status and level of care
• Understanding of Care Management best practices
• Ability to research and reason best practices to support process improvement
• Strong verbal and electronic communication skills
• Ability to analyze, evaluate, and monitor data in addition to providing action plans
• Knowledge of CMS Conditions of Participation for Discharge Planning
• Knowledge of Managed Care and Value Based Programs

Benefits

Includes benefits such as medical, dental, vision insurance, life insurance, disability insurance, paid time off, 403-B retirement plan, whole person well-being resources, mental health resources and support, pet benefits, and more.

Pay

$94,083.61 - $175,003.55

Schedule

Full time, Day shift, Weekend (United States of America)