Director Case Management

Director Case Management Overview

• The Director Case Management oversees case management, utilization review, and discharge planning to ensure optimal resource utilization and patient outcomes.
• Lead interdisciplinary teams to drive quality improvement and regulatory compliance in patient care and resource management.
• Collaborate with healthcare professionals to optimize patient throughput and reduce readmissions and denials.
• Ensure adherence to CMS, accreditation, and payer requirements while maintaining high standards of care.
• Monitor and analyze performance metrics to identify areas for improvement and implement solutions.
• Provide leadership and mentorship to case management and social work teams, fostering professional growth.
• Utilize advanced analytical skills to evaluate data and improve care coordination processes.
• Support organizational goals through effective care coordination and resource management strategies.

Director Case Management Key Responsibilities & Duties

• Lead case management, social work, and utilization review teams to achieve organizational objectives.
• Develop and implement strategies to improve patient throughput and reduce length of stay.
• Collaborate with interdisciplinary teams to address barriers to care and discharge planning.
• Monitor compliance with regulatory standards and accreditation requirements.
• Analyze performance data to identify trends and opportunities for quality improvement.
• Provide training and development opportunities for case management staff.
• Ensure effective utilization management and denial prevention strategies.
• Maintain knowledge of Milliman and InterQual criteria for effective case management.

Director Case Management Job Requirements

• Bachelor of Science in Nursing (BSN) or related field required.
• Minimum of 5 years of experience in case management or related field.
• Licensed clinician in the state of practice, meeting regulatory requirements.
• Preferred certification in case management and current BCLS certificate.
• Knowledge of Milliman and InterQual criteria preferred.
• Strong analytical skills to evaluate data and implement improvements.
• Proficiency in basic to intermediate computer skills for data management.
• Experience in leading teams and driving organizational goals effectively.