Registered Nurse Director Case Management

Overview

• Lead the Care Management department, driving strategic initiatives to enhance patient care and ensure regulatory compliance.
• Collaborate with multidisciplinary teams to optimize care delivery and streamline discharge planning processes.
• Foster a culture of accountability and excellence within the Care Management team.
• Act as a liaison with community agencies to support post-hospital care and patient transitions.
• Interpret and enforce policies from governing bodies such as CMS and Joint Commission.
• Participate in strategic meetings to improve patient care efficiency and outcomes.
• Provide leadership and mentorship to the Care Management team, fostering professional growth and development.

Key Responsibilities & Duties

• Develop and implement effective care management programs aligned with accreditation standards.
• Conduct chart reviews to assess care intensity and ensure appropriate discharge planning.
• Collaborate with Physician Advisors to address cases not meeting criteria.
• Identify and resolve avoidable delays in patient care processes.
• Ensure compliance with mandatory reporting requirements for CPS and APS cases.
• Educate staff on compliance policies and care management best practices.
• Monitor and report on care management metrics to drive continuous improvement.
• Lead initiatives to enhance patient satisfaction and care outcomes.

Job Requirements

• Bachelor's Degree in Nursing required; Master's in Nursing or Healthcare Administration preferred.
• Minimum 4-6 years of clinical nursing experience; 3-5 years in care management or utilization review.
• At least 1-3 years of leadership experience in a healthcare setting.
• Proficiency in electronic medical records and care management software.
• RN licensure and Basic Life Support certification required within seven days of hire.
• Strong knowledge of care management principles and regulatory compliance.
• Commitment to patient-centered care and continuous quality improvement.
• Excellent communication and leadership skills to effectively manage teams.