Nurse Director Case Management

Overview

• Lead a dynamic Case Management team to ensure efficient patient care coordination and discharge planning in a fast-paced healthcare environment.
• Oversee utilization management processes to optimize resource allocation and improve patient outcomes.
• Develop and implement comprehensive case management programs aligned with hospital mission and patient needs.
• Provide strategic leadership and supervision to case managers, social workers, and clinical coordinators.
• Collaborate with multidisciplinary teams to enhance care delivery and reduce readmissions.
• Utilize continuous quality improvement tools to integrate and coordinate case management services effectively.
• Foster a culture of collaboration and innovation within the case management department.
• Ensure compliance with regulatory standards and hospital policies in all case management activities.

Key Responsibilities & Duties

• Direct and supervise the activities of case managers, social workers, and utilization review coordinators.
• Develop and implement policies and procedures for effective utilization management and discharge planning.
• Analyze data and statistics to identify trends and opportunities for improvement in case management processes.
• Collaborate with clinical teams to design patient-centered care plans that address individual needs.
• Monitor compliance with Milliman and InterQual criteria for utilization review activities.
• Provide training and professional development opportunities for case management staff.
• Ensure timely and accurate documentation of all case management activities.
• Lead initiatives to improve patient satisfaction and reduce hospital readmissions.

Job Requirements

• Bachelor of Science in Nursing (BSN) required; CA Registered Nurse license mandatory.
• Minimum 5 years of experience in a case management position; 7 years preferred.
• Proficiency in Milliman and InterQual criteria for utilization review processes preferred.
• Strong analytical skills for problem identification and data evaluation.
• Knowledge of basic to intermediate computer skills essential.
• Current Basic Life Support (BCLS) certification preferred.
• Experience in leading multidisciplinary teams in a healthcare setting.
• Sign-on and relocation benefits available for qualified candidates.