Summary SUMMARY: Plans, directs, and evaluates the activities of the Case Management team. Plans, organizes, implements, and evaluates delivery of care management and discharge planning to ensure appropriate utilization management thereby minimizing denials and appeals. Ensures compliance with regulatory agencies and ensures third party payers' reimbursement/coverage is approved to meet patients' level of care.
Directs, plans, implements and evaluates case management of patient care across the continuum of care. Collaborates with other directors in the LBH system to establish and standardize goals and objectives for the department. Develops and implements policies and procedures supporting quality patient driven care through efficient and effective case management. Develops length of stay (LOS) and resource reduction strategies, focusing on facility best practice. Provides specific LOS analysis and makes recommendations for process improvement.
RESPONSIBILITIES: Coordinates, provides oversight and manages the Care Management Department. Assists the leadership in developing and maintaining an efficient Care Management program within the context of the current healthcare landscape. Develop programs that meet hospital, regulatory, system and customer needs. Ensures programs are current with regulatory requirements. Assures that the RN Care Managers, Social Workers and Care Management Assistants proactively coordinate care while planning for a quality discharge. Provides interdisciplinary leadership to promote collaboration improving care coordination. Engages in negotiations to resolve discharge barriers and improve collaboration/continuum of care/patient safety to avoid unnecessary denials and extended lengths of stay. Utilizes best practices and benchmark data to guide the development of program goals. Maintains sound department operations that support the fiscal goals of the department, hospital, and system. Develops financial projections, prepares and effectively monitors and operates within the approved budget to ensure optimal financial departmental performance. Monitors hospital indicators impacted by department and adjust departmental activities accordingly. Interprets LifeBridge Health financial indicators to case management staff. Collaborates with leadership to critique and analyze data from regulatory agencies. Provides feedback to the interdisciplinary team regarding length of stay and denial. Leads the Care Management Department to meet current best practices and develops departmental strategy that supports the division. Provides leadership and supervision to departmental personnel to accomplish department and hospital goals Consults with other leaders and organizations to keep informed of trends in healthcare, management, patient care practices, and new initiatives to integrate new concepts and practices. Establishes goals and objectives for the department. Responsible for directing and blending divisional long-range goals with those of the department and hospital. Leads staff in identifying customer needs; ensures integration into departmental and divisional strategic and operational plans and directs good customer relations. Ensures staff has access to resources/tools/education to perform their duties. Assures that staff meet professional standards; and that care coordination implements best practice and is positioned to serve the needs of patients while meeting performance objectives. Leads the CM team in focus on appropriate utilization of hospital levels of care and resources. Ensures that patients are treated in the most appropriate care environment. Supports the standardization of managing denials, lengths of stay and patient and employee satisfaction across the system. Work with Corporate Director to assist in the provision and monitoring of case management data such as LOS, readmissions, HCAPS and 2 MN, identify areas of concerns, and strategies for potential resolution. Actively participates in overall departmental performance improvement by collaborating with the staff to direct the performance improvement process. This includes tracking departmental improvements. Ensures that the department meets the needs of their customers to include, patients, medical staff, external agencies, professional staff and others. Works collaboratively with customers to identify needs. Provides education, mentoring, training and guidance to staff, functioning a role model. Serves as liaison to extended care agencies. Develops and maintains positive relations with external agencies. Initiates inter-agency processes to improve continuum of care and avoid denials and unnecessary lengths of stay. Engages in negotiation to resolve discharge barriers and improve inter-agency collaboration. Page 1 of 4 | July 28, 2026 Selects, develops, manages and evaluates direct reports; and oversees the selection, development, management and evaluation of indirect reports. Promotes staff development and education. Provides opportunity for formal and informal education to promote ongoing staff competency. Sets standards for performance and ensures timely completion of performance appraisals.
QUALIFICATIONS AND REQUIREMENTS: - 5-7 years of relevant experience; nursing degree or MSW
- Required: Current Maryland Registered Nurse (RN) licensure; or Social Worker, Counselor or Psychologist License
- Preferred: Certified Case Manager certification
