5 years of clinical experience; 2 years in case management
Experience with utilization management (InterQual) preferred
Case Management certification (CCM/ACM) preferred within 2 years of hire
Knowledge of federal/state regulations regarding care management
Responsibilities
Lead the care management team in aligning with health care trends
Drive improvements in patient transitions across care levels
Enhance departmental performance and foster a positive culture
Ensure compliance and accreditation standards are met
Oversee discharge planning and utilization review processes
Cultivate relationships with internal and external stakeholders
Monitor and enhance quality and safety outcomes
Benefits
Comprehensive health benefits including medical, dental, and vision
Generous paid time off and holiday schedule
Retirement plans with employer matching contributions
Opportunities for professional development and certification
Supportive work environment fostering collaboration and patient-centered care
Full Job Description
JOB SUMMARY
The Director of Care Management is a nurse care management professional who leads the care management team of case managers, care transition nurses, social work professionals and additional members of the care management team in response to the ever-changing landscape of health care. The Director of Care Management is in a position to positively affect the transition of care of patients across the continuum, work with all levels of providers, and support the financial well-being of the organization. Most importantly, the Director of Care Management drives good patient outcomes. Areas of primary responsibility are the overall performance, growth and culture of the Care Management Department; compliance and accreditation related to care management; discharge planning; utilization review/management; internal organization department relationships; external relationships; and quality and safety outcomes.
JOB QUALIFICATIONS
Education:
Graduate of an accredited school of nursing.
A BSN from an accredited school is required within four (4) years from date of hire into the Case Manager role.
Masters in nursing or DNP are preferred.
Five (5) years clinical experience with two (2) years' experience in case management / one (1) year utilization management experience (InterQual) preferred.
Certifications/Licenses:
Certification in Case Management such as CCM or ACM will be accomplished within 2 years of hire into the Case Manager and/or Care Manager Supervisor role, preferred.
Job Knowledge and Skills:
Knowledge of professional nursing practices and standards of care.
Ability to assess patient conditions and respond appropriately to changes in patient status.
Strong clinical judgment and critical thinking skills.
Ability to administer medications and treatments safely and accurately.
Proficiency in electronic health record (EHR) documentation.
Strong communication and patient education skills.
Ability to prioritize tasks and manage multiple patient care responsibilities.
Ability to work effectively in a team-based healthcare environment.
Commitment to providing compassionate, patient-centered care
Knowledge of federal, state, TJC and CMS standards and quality improvement regulations is required.
