Case Management DirectorPosted: July 12, 2019
Responsible and accountable for clinical and financial operations of the Case Management system. The Director provides hospital-wide leadership through effective managerial and educational direction in the areas of Case Management operations, resource management, patient flow through the continuum, DRG financial analysis, change management, managed care, guidelines/protocols, clinical documentation and system improvement. Independent action is required to ensure an integrated process which will coordinate health care delivery across service lines. Frequent interfaces with Senior Leadership, Medical Staff, Quality, Ancillary Services and Nursing in a communicative and change management capacity. Promotes high quality patient care and cost effectvieness by proactively coordinating the entire spectrum of a patient's care; facilitating positive outcomes with appropriate use of resources.
Directs, supervises evaluates and oversees functions of the Case Management department to include social services, discharge planning and utilization review. This includes the Case Management staff (Care Managers, MSW's, Clinical Documentation Specialists, and Administrative Assistants.
Schedule: Full Time (40 Hours Per Week)
Contact: Anthony Ralph
Education and/or Experience:
- Graduate of an accredited school of nursing with a BSN, or possess a Masters of Social Work.
- Current licensure to practice as a Registered Nurse or Social Worker in the State of New Mexico.
- Certificate in Case Management preferred.
- Current BCLS (RN) or Hands Only CPR (MSW).
- Requires a minimum of three (3) years recent care or similar nursing, CM experience.
- Three years (3) demonstrated management in related field, in a fast pace, complex environment.
- Multidisciplinary approach to clinical improvement.
- Fiscal Management.
- Managed Care concepts and strategies; DRG reimbursement.
- Convert DRG and Physician practice pattern data information into quantifying data which impacts costs and quality.
- Ability to implement new programs and problem solving mechanisms.
- Strong interpersonal communication skills.
- Experience in developing and presenting education programs.
- Competent computer skills to include Microsoft Office programs.
- Excellent knowedge of Medicare/Medicaid/Third Party admission and concurrent review criteria.
- Knowledge of "Benchmark" and "Best Practice" methodologies.
- Ability to implement and initiate workload changes and set priorities.
- Case Managment Practice/Guidelines, to include analyzing, trending and reporting variances.
- Working knowledge of Milliman or Interqual criteria.
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