Director, Case Management

About the Role

Directs, plans, implements, and evaluates all activities of the case management program. Develops processes to monitor utilization review, including 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 with requirements and to secure third-party payer reimbursement/coverage for 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.

Responsibilities

• Leads a functional unit by developing, communicating, and building consensus for goals/programs that support the 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 and 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 the effectiveness of patient care standards, policies, and procedures to improve the 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 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.

Requirements

• Master's Degree in Nursing or related field required, or equivalent combination of education and related experience. Bachelor's or Master's 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.

Pay

The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget, and internal equity).