Director, Case Management
The Director of Case Management is responsible for the development, planning, coordination and administration of the activities of Utilization Review and Resource Management;
responsibilities include facility wide direction of quality and cost-efficient patient care. The CMD will be responsible for administrative duties as well as all duties associated with a floor Case Manager .
Responsibilities :
Ensures that the Case Management organization complies with all healthcare regulations, nursing regulations, Joint Commission, & co.
policies & procedures.
- Identifies ideas, actions, & processes to improve quality, reduce risk, & maintain patient safety.
- Maintains knowledge of healthcare delivery models, healthcare economics, and healthcare policy.
- Acts as a liaison with the nursing / medical staff, patient, families and community agencies to facilitate problem solving, post discharge care and coordination of services.
- Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
- Ensures the department financial budget is achieved.
- Effectively utilizes database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for Case Management processes and systems.
Requirements :
- Must possess Bachelor's in Nursing (BSN) degree, Masters in Nursing, Health Care or Business Administration, preferred.
- Five to seven years' experience in Case Management, discharge planning, and / or utilization review.
- Minimum of five years clinical Nursing in an acute care setting.
- Knowledge of regulatory and payer requirements for reimbursement and reasons for denials by auditors.
Director, Case Management
The Director of Case Management is responsible for the development, planning, coordination and administration of the activities of Utilization Review and Resource Management; responsibilities include facility wide direction of quality and cost-efficient patient care. Effectively utilizes database ma...
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