Case Management Director- Nursing

Job Description

General Summary of Duties:
The Director of Case Management’s primary responsibilities include: The manager of case management is responsible and accountable for the implementation of the case management program at the hospital level. The components/roles of the inpatient case management program consist of the following: care facilitation, utilization management, case management, and discharge planning.

Supervises:  Case Managers and Social Workers

Duties Include But Are Not Limited To:

• Provide leadership, education, and supervision for the day-to-day workflow of Case Managers and Social Workers.
• Monitor Case Management Department’s documentation to ensure meets regulatory compliance.
• Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data (e.g., Avoidable Days, Readmissions).
• Maintain skills in case management and utilization review to allow for coverage of patient caseload to cover staffing needs of all areas of the hospital.
• Communicate with physicians concerning patient needs and aid with development of appropriate plan of treatment and assist with level of care and bed placement assignments.
• Directly responsible for personnel actions including hiring, performance appraisals, employee schedules, and maintain payroll records and time reports in KRONOS.
• Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care.
• Participate in discharge planning. Provides necessary education and resources to meet the discharge needs of individual patients and families.
• Active participant of Utilization Review Committee and Revenue Recycle Committee.
• Promote efficient utilization of clinical resources.
• Promotes the appropriate amount of resources are used based on patient acuity.
• Assures appropriate level of understanding, awareness, and compliance with all applicable Joint Commission, CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures, and professional standards.
• Other duties as assigned.

Must-Haves:

1. Graduate of a program of Registered Nursing.
2. Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management program.
3. Current RN license in the state of Iowa or a multistate license allowing to work in the state of Iowa

Knowledge, Skills & Abilities:

• Working knowledge of payer requirements and discharge planning regulations that support the effect for the development of departmental policies, procedures, and standards.
• Working knowledge of Medicare, managed care, inpatient, outpatient, and home health continuum, as well as utilization management, discharge planning, and case management.
• Ability to work collaboratively with healthcare professionals at all levels to achieve established goals and improve quality outcomes.
• Working knowledge of concepts associated with performance improvement.
• Self-motivated, proven communication skills, assertive, able to work independently and as a team member.
• Demonstrated effective working relationships with physicians.

Education:

• Graduate of a program of Registered Nursing.
• Bachelor of Science in Nursing degree preferred.

Experience:

• Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management program.
• Two to three years previous management experience is preferred with a minimum of two years’ experience in hospital-based nursing.

Certificate/License:

• Iowa Mandatory Reporter – Child and Dependent Adult Abuse Certificates
• Current RN license in the state of Iowa or a multistate license allowing to work in the state of Iowa

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