Director of Case Management

Overview

• Lead and manage the Care Management and Resource Management programs to ensure regulatory compliance and patient-centered care.
• Collaborate with multidisciplinary teams to optimize patient outcomes and discharge planning processes.
• Provide leadership and direction to the Care Management team, fostering accountability and professional growth.
• Ensure compliance with federal and state laws, accreditation standards, and organizational policies.
• Act as a liaison to community agencies for post-hospital placement and support services.
• Participate in Patient Care Conferences and Length of Stay meetings to support efficient care delivery.
• Oversee accurate and timely reporting of CPS or APS cases, ensuring staff education on mandatory reporting requirements.
• Contribute to continuous quality improvement initiatives and patient-centered care strategies.

Key Responsibilities & Duties

• Implement and maintain effective Care Management programs meeting regulatory and accreditation standards.
• Provide leadership to staff, ensuring adherence to roles and accountability for duties.
• Conduct chart reviews to evaluate severity of illness and intensity of services for admissions and discharges.
• Coordinate discharge planning and social services functions to ensure compliance with standards.
• Identify avoidable days and implement communication systems to address and resolve them effectively.
• Act as a liaison to community agencies, providing resources for post-hospital placement and support.
• Interpret and enforce policies and regulations set by governing bodies, ensuring department compliance.
• Participate actively in Patient Care Conferences and Length of Stay meetings for efficient care delivery.
• Perform other duties as assigned, adhering to organizational policies and standards.

Job Requirements

• Bachelor's Degree in Nursing required; Master's Degree in Nursing or Healthcare Administration preferred.
• Minimum of 4-6 years of clinical nursing experience and 3-5 years in care management or utilization review.
• 1-3 years of leadership experience in a healthcare setting required.
• Strong knowledge of care management principles, discharge planning, and regulatory compliance requirements.
• Proficiency in electronic medical records (EMR) and care management software.
• RN – Registered Nurse licensure and BCLS certification required.
• Excellent leadership, communication, and interpersonal skills for collaboration with multidisciplinary teams.
• Commitment to patient-centered care and continuous quality improvement initiatives.
• Competitive benefits package including 401(k) match, PTO, and health insurance options.