RN Director of Care Management

Role

The Director, Care Management oversees the implementation, development, and management of the Care Management and Resource Management programs. This position ensures compliance with all regulatory requirements, establishes efficient processes for patient care and discharge planning, and provides leadership to the Care Management team.

About the Role

This position works collaboratively with staff, physicians, and community resources to deliver patient-centered care and achieve optimal outcomes.

Essential Functions

• Oversees the implementation and maintenance of an effective and compliant Care Management program that meets all regulatory and accreditation standards.
• Provides leadership and direction to staff, ensuring accountability for duties and adherence to roles within their scope of practice.
• Conducts chart reviews to evaluate severity of illness (SI) and intensity of services (IS) for admissions, continued stays, and discharge planning.
• Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up.
• Identifies avoidable days and implements communication systems to address and resolve them effectively.
• Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning.
• Maintains regular and reliable attendance. Complies with all policies and standards.

Leadership Responsibilities

• Supervision and Staff Management: Provides leadership, mentorship and professional development opportunities for departmental staff. Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues. Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development.
• Strategic Planning and Financial Oversight: Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning. Monitors expenditures, ensuring cost-effective delivery of services. Evaluates and implements new technologies to enhance operational efficiency. Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies.

Quality Assurance and Regulatory Compliance

• Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards.
• Participates in audits, inspections and accreditation processes as applicable. Follows established quality control practices to ensure accuracy, consistency and safety.

Collaboration and Communication

• Works closely with leadership teams to coordinate and improve service delivery. Stays up-to-date with industry advancements, new technologies, and regulatory changes. Stays informed about regulatory changes and updates.

Qualifications

• Bachelor's Degree in relevant field required or Seven (7) plus years of direct experience in lieu of a Bachelor's degree required.
• Master's Degree preferred.
• Three to five (3-5) years of experience in closely related field with Bachelor's degree required.
• Three to five (3-5) years of previous leadership experience preferred.

Knowledge, Skills And Abilities

• Strong leadership, organizational, and communication skills.
• Ability to collaborate with interdisciplinary teams and manage cross-functional relationships.
• Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement.
• Communicate effectively with leadership, team members, and stakeholders.
• Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines.
• Problem-solving and critical thinking skills.
• In depth knowledge of industry best practices and regulatory compliance (if applicable).
• Strong organizational and time management skills.
• Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required.
• BCLS - Basic Life Support within seven (7) days of hire or transfer to position required.