Case Management Director oversees a staff of case managers responsible for patient care coordination. Develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting or negotiation. Being a Case Management Director evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Seeks treatments that balance clinical and financial concerns with the family's needs and the patient's quality of life. Additionally, Case Management Director contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care. Typically requires a bachelor's degree. Typically reports to top management. May require Registered Nurse (RN). The Case Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Case Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
Job Summary: Responsible for acute care sites of service to assess, plan, facilitate, and integrate coordinated care for patients from preadmission/ED through discharge with a plan of care that supports post discharge care needs across the continuum. Addresses barriers, social determinants of health, high utilizers of sites of service, supports and integrates psychosocial and legal components that impact the patient and the plan of care. Coordination of post discharge services including but not limited to when applicable per patient needs: placement, durable medical equipment, home health, personal care services, and other complex care support needs. Consults with the multi-disciplinary teams, committees, Service Lines, Providers, and the patient/family. Compliant with state, federal, hospital and TJC guidelines. Follow the standard work for the Case Management department which includes but not limited to discharge planning starts on admission, timely documentation, education on patient plan of care, reporting to Adult Protective Services (APS)/Child Protective Services (CPS), required documentation to support discharge planning functions, resource identification, and other duties as assigned.
Qualifications: BSW - Bachelor’s degree in Social Work or related field from a recognized college or university required. At least 1 year social work experience required. Experience in case management, home health, quality and/or utilization management, community or hospital setting preferred. Thorough knowledge of general nursing/social work principles, methods, techniques, community resources, discharge planning processes, and State/Federal laws as they relate to Case Managers role. Exemplary verbal and written communication, critical thinking, interpersonal/group/leadership negotiation skills, and detail-oriented focus. Ability to communicate well with patients, family, staff, providers, service lines, and community resources to promote positive outcomes. Proficient in computer skills and MS Office software. BLS preferred for hire but required completion within 3 months of hire date.
MSW - Master's degree in Social Work or related field from a recognized college or university required. At least 1 year social work experience required. Experience in case management, home health, quality and/or utilization management, community or hospital setting preferred. Thorough knowledge of general nursing/social work principles, methods, techniques, community resources, discharge planning processes, and State/Federal laws as they relate to Case Managers role. Exemplary verbal and written communication, critical thinking, interpersonal/group/leadership negotiation skills, and detail-oriented focus. Ability to communicate well with patients, family, staff, providers, service lines, and community resources to promote positive outcomes. Proficient in computer skills and MS Office software. BLS preferred for hire but required completion within 3 months of hire date.
RN - Associates degree in Nursing from a recognized college or university required; advanced degree preferred BSN/MSN. Certification in Case Management preferred. Two years nursing experience. Experience in case management, home health, quality and/or utilization management, community or hospital setting preferred. Thorough knowledge of general nursing/social work principles, methods, techniques, community resources, discharge planning processes, and State/Federal laws as they relate to Case Managers role. Exemplary verbal and written communication, critical thinking, interpersonal/group/leadership negotiation skills, and detail-oriented focus. Ability to communicate well with patients, family, staff, providers, service lines, and community resources to promote positive outcomes. Proficient in computer skills and MS Office software. BLS preferred for hire but required completion within 3 months of hire date.
EOE AA M/F/Vet/Disability
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