Director Case Management

Overview

• Lead a dynamic Case Management Team, ensuring efficient patient care coordination and utilization management.
• Drive strategic initiatives to enhance quality care and reduce hospital readmissions.
• Oversee discharge planning and care coordination processes for optimal patient outcomes.
• Develop and implement comprehensive Case Management programs and systems.
• Collaborate with multidisciplinary teams to align services with hospital mission and patient needs.
• Provide leadership and supervision to case managers, social workers, and clinical coordinators.
• Utilize continuous quality improvement tools to enhance service delivery.
• Foster a collaborative and fast-paced healthcare environment for professional growth.

Key Responsibilities & Duties

• Manage utilization review and discharge planning processes to optimize patient care.
• Develop and oversee Case Management programs aligned with hospital objectives.
• Supervise and mentor case managers, social workers, and clinical coordinators.
• Ensure compliance with regulatory standards and hospital policies.
• Analyze data and statistics to identify areas for improvement in patient care.
• Collaborate with healthcare teams to coordinate services and resources effectively.
• Implement strategies to reduce readmissions and enhance patient satisfaction.
• Utilize Milliman and InterQual criteria for case evaluations and decisions.

Job Requirements

• Active California Registered Nurse license and Bachelor's of Science in Nursing.
• Minimum 5 years of experience in Case Management or related roles.
• Master of Business Administration (MBA) preferred for strategic leadership.
• Knowledge of Milliman and InterQual criteria for utilization review.
• Proficiency in basic to intermediate computer skills for data analysis.
• Strong analytical skills for problem identification and evaluation.
• Current BCLS certification preferred for clinical expertise.
• Experience in leading multidisciplinary teams in healthcare settings.