Director - Case Management
Department: Case Management
Schedule: Full Time
Lead and oversee case management activities across the care continuum to include discharge planning, social work, utilization review, care coordination, reimbursement, denial management, CAP case management and HIV case management services. Collaboratively participate in activities focused on care transitions and value-based purchasing initiatives. Maintain current knowledge of regulatory guidelines and reimbursement systems including Medicare, Medicaid, Managed Medicare Programs, Commercial Payers and Ryan White federal regulations. Maintain competency of current coding practices and compliance issues related to services provided to patients in the hospital and community care environment. Provide information to medical staff, interdisciplinary team and management pertaining to appropriate resource utilization, cost and quality indicators. Collaboratively identify opportunities for improvement and education related to cost effective resource consumption and fiscally responsible plans of care.
Registered Nurse or Social Worker with a Bachelor's Degree required and Master's Degree preferred. Certification in case management, utilization review or quality highly desirable. Strong organizational and management skills with an ability to manage multiple priorities. Creativity, flexibility and ability to adapt to a changing environment. Knowledge of clinical treatment modalities and post-acute and community healthcare delivery systems is required. Strong interpersonal and communication skills, both oral and written. Minimum of five years experience in an acute care hospital is required. Previous experience and knowledge of case management, utilization management processes and performance improvement techniques are necessary. Demonstrated experience leading case management functions including supervising managers and key staff members. In-depth knowledge of Medicare, Medicaid and third party payer systems. Experience and expertise with managing resources, length of stay, insurance denials, improving reimbursement and addressing recovery audit contractor issues.