Director of Case Management

General Summary of Position
Plans organizes coordinates and directs the Utilization Case Management and Discharge Planning Programs. Monitors discharge planning services and counseling to patients and their families and consultation to medical staff regarding patient management.

Primary Duties and Responsibilities

• Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.

• Develops and recommends department operating budget and manages resources according to approved budget.
• Selects trains orients and assigns department staff. Delegates tasks as appropriate. Develops standards of performance evaluates performance and conducts performance management planning. Identifies individual staff development needs and provides appropriate resources to meet needs. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchange information.
• Contributes to the development review revision and implementation of clinical pathways procedures and guidelines at the hospital and system level.
• Coordinates the facilitation of patient transition from area to area in a timely cost effective manner. Assures that the hospital-based program encompasses preadmission emergency room admitting acute care discharge follow-up sub-acute and rehabilitation.
• Directs and participates in the provision of social services in the areas of psychosocial assessment and counseling crisis intervention child abuse home health care oncology and other support groups' discharge planning.
• Ensures the delivery of quality care to inpatients and outpatients by identifying patient needs and developing social service programs to meet those needs.
• Monitors and evaluates the effectiveness of policies and practices with regard to length of stay and utilization of resources.
• Oversees monthly monitoring and reporting of critical data on LOS discharges clinical and teaching outcomes denials overturned denials and other reports.
• Provides direction and support regarding Utilization Management Case Management Discharge Planning and Social Work.
• Serves as the hospital liaison to payers in matters pertaining to utilization of acute care services. Makes recommendations regarding third party case management contracts.
• Participates in meetings and on committees and represents the department and business unit in community outreach efforts. Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments.

Minimal Qualifications
Education

• Master's degree in Nursing (MSN) Healthcare Administration Business Administration or related field required

Experience

• 3-4 years 4 years progressive leadership preferred and
• Experience in CM/SW/UR required

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Maryland or District of Columbia Upon Hire required and
• CCM - Certified Case Manager within 90 Days preferred

Knowledge Skills and Abilities

• Excellent problem-solving skills and ability to exercise independent judgment.
• Business acumen and leadership skills.
• Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
• Working knowledge of various computer software applications preferred.