Registered Nurse Director Case Management

Overview

• Lead the Care Management department, ensuring compliance with regulatory standards and efficient patient care processes.
• Provide strategic direction and leadership to the Care Management team, fostering accountability and adherence to roles.
• Collaborate with staff, physicians, and community resources to deliver patient-centered care and achieve optimal outcomes.
• Oversee discharge planning and social services functions, ensuring compliance with federal and state laws.
• Act as a liaison to community agencies, providing resources for post-hospital placement and support.
• Interpret and enforce policies set by CMS, Joint Commission, and other governing bodies.
• Participate in Patient Care Conferences and Length of Stay meetings to support efficient care delivery.

Key Responsibilities & Duties

• Implement and maintain an effective Care Management program meeting accreditation standards.
• Conduct chart reviews to evaluate severity of illness and intensity of services for admissions and discharge planning.
• Refer cases not meeting criteria to Physician Advisor or Utilization Management Committee.
• Identify avoidable days and develop communication systems to address and resolve them.
• Ensure accurate and timely reporting of CPS or APS cases as mandated.
• Educate staff on mandatory reporting requirements and compliance policies.
• Perform other duties as assigned, complying with all organizational policies and standards.

Job Requirements

• Bachelor's Degree in Nursing required; Master's Degree in Nursing or Healthcare Administration preferred.
• 4-6 years of clinical nursing experience and 3-5 years 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 and Basic Life Support certification required within seven days of hire.
• Commitment to patient-centered care and continuous quality improvement.