RN Nurse Director – Case Management

Overview

• Lead the Care Management department, ensuring compliance with regulatory standards and efficient patient care processes.
• Provide strategic direction for care management programs, enhancing patient outcomes and operational effectiveness.
• Collaborate with multidisciplinary teams to implement patient-centered care and discharge planning strategies.
• Oversee staff performance, fostering accountability and adherence to professional roles.
• Act as a liaison to community agencies, ensuring seamless post-hospital support and placement.
• Interpret and enforce healthcare policies, ensuring compliance with CMS, Joint Commission, and other governing bodies.
• Participate in Patient Care Conferences and Length of Stay meetings to optimize care delivery.
• Ensure timely reporting of CPS or APS cases and educate staff on mandatory reporting requirements.

Key Responsibilities & Duties

• Develop and maintain effective care management programs aligned with regulatory standards.
• Conduct chart reviews to assess severity of illness and intensity of services for admissions and discharge planning.
• Refer cases not meeting criteria to appropriate committees and ensure follow-up actions.
• Identify avoidable days and implement communication systems to address and resolve them.
• Coordinate discharge planning and social services functions to ensure compliance with laws and standards.
• Provide leadership and direction to staff, ensuring accountability and adherence to roles.
• Actively participate in Patient Care Conferences and Length of Stay meetings.
• Ensure compliance with healthcare policies and standards set by governing bodies.

Job Requirements

• Bachelor's Degree in Nursing required; Master's Degree in Nursing or Healthcare Administration preferred.
• Minimum of 4 years of clinical nursing experience; 6 years preferred.
• 3-5 years of experience in care management or utilization review required.
• 1-3 years of leadership experience in a healthcare setting required.
• Strong knowledge of care management principles, discharge planning, and regulatory compliance.
• Proficiency in electronic medical records and care management software.
• RN licensure required; BCLS certification within seven days of hire.
• Excellent leadership, communication, and analytical skills.