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)
ScionHealth is committed to a culture of service excellence as demonstrated by our employees’ adherence to the service excellence principles of Pride, Teamwork, Compassion, Integrity, Respect, Fun, Professionalism, and Responsibility.
As our most acute level of care, our specialty hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit, but for an extended recovery period. Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients.
Job Summary: The Director of Case Management directs the Case Management and Utilization Management activities in a Kindred hospital. Oversees the facilitation of care coordination of the patient and family through the management of quality clinical service delivery. Partners with external customers, referral sources and payors to ensure the facilitation and coordination of the discharge planning process and serve as the patient and family advocate. Accountable for the facility’s denial management program. Ensures that case management services comply with the Conditions of Participation. Collaborates closely with the hospital CEO/Administrator, COO, CFO, CCO and District Office.
Essential Functions:
Education:
Graduate of an accredited program required:
RN or BSN preferred; or Masters of Social Work with licensure as required by state regulations; or Master’s degree in healthcare administration, business administration, or clinical specialty
Licenses/Certification:
Healthcare professional licensure required as Registered Nurse, Licensed Clinical Social Worker (LCSW),or Licensed Social Worker (LSW), as required by state.
Certification in Case Management preferred.
Experience:
Minimum three years’ experience in Hospital Case Management.
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