Job Description
Job Description
Job Description
**Position Overview** We are looking for a seasoned Director of Case Management to oversee and manage the Case Management unit. This role is crucial for ensuring effective clinical resource management, supporting discharge planning, advocating for patients, and adhering to best practices regarding medical necessity determination and concurrent reviews.
. **Essential Functions**
**Leadership & Management**
Direct and supervise the operations of the Case Management unit, focusing on staffing, performance improvement, and setting departmental goals that align with the hospital's strategic plan.
Create a supportive, growth-oriented atmosphere while offering professional development opportunities for staff. Guide and coordinate care management activities in accordance with RRHS policies and relevant regulatory standards, such as those set by CMS and the Joint Commission.
**Clinical Oversight & Patient Care Coordination** Collaborate closely with physicians, nurses, and other healthcare providers to facilitate multidisciplinary decision-making around patient care. Continuously monitor and evaluate the quality of patient care, working with staff to ensure the best possible outcomes. Implement evidence-based practices and clinical protocols within care management operations.
**Compliance & Reporting** Educate the staff on case management standards, regulatory requirements, and best practices. Ensure compliance with all applicable federal and state regulations, including Conditions of Participation, OSHA, and HCFA guidelines. Maintain an up-to-date knowledge of payer issues and strategies aimed at optimizing revenue capture and cost reduction during the patient’s stay.
**Operational Excellence** Analyze patient data and trends to identify areas for service improvement and operational efficiencies. Partner with post-acute service providers to streamline patient transitions and enhance community care after discharge. Actively participate in strategic planning and performance improvement initiatives across RRHS and corporate teams.
**Qualifications**
**Education & Licensing**
An Associate's Degree in Nursing is required, while a Bachelor’s or Master’s Degree in Nursing or a related field is preferred. Applicants must hold a valid RN license to practice in NC or possess a multi-state compact license.
**Certifications**
BLS certification is required; ACMA Certification is preferred. Candidates should obtain CCM Certification within the first year of employment or upon transferring to this role.
**Skills & Experience**
A minimum of 3 years of RN experience in acute care or care coordination is essential, along with at least 3 years of preferred management experience.
Strong critical thinking and decisive judgment skills are important, as is the ability to work independently with minimal supervision.
Candidates should possess a solid understanding of care management, discharge planning, and government payer requirements.
Proficiency in Interqual criteria, financial/budgetary processes, and government billing regulations is also required, along with exceptional communication, customer service, analytical, and problem-solving abilities.
The ability to juggle multiple tasks effectively while paying close attention to detail is crucial.
**Benefits** Choose from a variety of Medical, Dental, and Vision plans tailored to your needs.
Enjoy contributions to HSA and 401(K) retirement plans, along with generous Paid Time Off. Access Accident & Critical Illness Insurance and Prescription Assistance through OptumRx.
Benefit from family income protection programs, including life insurance, short/long-term disability, and identity theft protection. Utilize our no-cost Employee Assistance Program, available 24/7, which offers support for emotional, legal, financial, and everyday challenges. Additionally, take advantage of our free travel and entertainment discount program.
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Temporary work,