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About the Role

The Director, Case Management is responsible for the administration, direction, and evaluation of Case Management services. This role develops strategies for advancing case management, including utilization management, care coordination, and transition management, aligning with the hospital's mission, vision, and regulatory requirements. Key responsibilities include achieving performance goals and maintaining a consistent standard of excellence.

Responsibilities

Direct case management and social work activities to monitor quality of care, verify documentation, and ensure compliance.
Address and resolve patient/family and staff satisfaction issues.
Identify and intervene regarding length of stay (LOS) issues.
Develop and evaluate case management for high-risk/high-volume patients.
Implement and evaluate concurrent utilization review practices.
Effectively manage concurrent denials.
Utilize data to improve department activities and performance.
Collaborate with other department leaders for seamless integration of Case Management/Social Work services.
Monitor and maintain JCAHO, federal, and state regulatory readiness.
Identify and manage clinical revenue enhancement projects.
Assist with programs providing learning experiences for staff and students.
Participate in the formulation and revision of administrative and departmental case management policies and procedures.
Communicate and interpret policy additions/revisions to staff.
Use, protect, and disclose patients’ protected health information (PHI) in accordance with HIPAA standards.
Comply with Information Security and HIPAA policies and procedures.
Limit viewing of PHI to the absolute minimum necessary.

Requirements

Bachelor’s Degree in Nursing required.
Minimum of five (5) to ten (10) years acute care clinical experience.
Minimum of five (5) years case management leadership experience.
New York State Licensed Registered Professional Nurse.
Certification in Hospital Management Strongly Preferred.
Certification in Patient Review Instrument (PRI) and Screen.
Certification in Case Management.
Broad knowledge of medical, nursing, and allied health sciences, community resources, case management regulatory requirements, and the revenue cycle.
PC experience with word processing, spreadsheets, and case management/denials software.
Strong understanding of CMS Conditions of Participation related to utilization management, care coordination, and transition management.
Knowledge of HIPAA, privacy, healthcare laws, regulations, and standards.
Advanced Knowledge in MS Word and Excel.
Demonstrated leadership ability.
Ability to apply common sense understanding to carry out instructions.
Ability to deal with problems involving several concrete variables in standardized situations.
Strong managerial, leadership, and interpersonal skills.
Ability to initiate action, creatively solve problems, meet goals, and produce results through effective supervision.
Strong problem-solving and creative skills.
Ability to exercise sound judgment and make decisions based on accurate and timely analyses.
High level of integrity and dependability with a strong sense of urgency and results orientation.
Must possess a smart-phone or electronic device capable of downloading applications for multifactor authentication and security purposes.
Ability to move around the work area, sit, perform manual tasks, operate office equipment, extend arms, kneel, talk, and hear.
Perform light lifting (up to 15 pounds).
Ability to follow directions, collaborate with others, and handle stress.
Works in a well-lighted/ventilated office setting.
Subject to frequent interruptions.
Minimal occupational exposure to infectious diseases, bloodborne pathogens, hazardous chemicals, noxious odors, latex, or musculoskeletal injuries.
Operate Office machines properly and in accordance with Hospital safety standards.
Ability to work in accordance with Hospital Safety Standards.

Skills

Case Management
Utilization Management
Coordination of Care
Transition Management
Leadership
Interpersonal Skills
Problem Solving
Creative Skills
Judgment
Analysis
Integrity
Dependability
Urgency
Results Oriented
Word Processing
Spreadsheets
Case Management Software
Denials Software
MS Word
MS Excel

Location

New York

Work Type

Full-time
Onsite

Experience Level

5-10 years clinical experience
5 years leadership experience

Education Level

Bachelor’s Degree in Nursing
Master’s Degree in Nursing preferred
Other health care related courses preferred

About the Company

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.

Equal Opportunity

Med-Metrix will not discriminate against any employee or applicant for employment because of race, color, religion, sex (including pregnancy, gender identity, and sexual orientation), parental status, national origin, age, disability, genetic information (including family medical history), political affiliation, military service, veteran status, other non-merit based factors, or any other characteristic protected by federal, state or local law.