The Director of Case Management provides training and direction to support Case Manager's effectively completing assigned responsibilities; managing caseloads, interpreting regulations, policies, operational procedures, and objectives; reviewing operations in assigned area to ensure a high level of quality that is consistent with organizational standards. Additionally the DCM participates in utilization review activities; performs case management analysis; and oversees concurrent review functions with appropriate follow-up action plan and intervention.
This position is also responsible for relationship building, as defined through targeted goals of the business plan, with insurance companies, self-insured employers, case management firms, and/or other health care networks. The DCM participates, as appropriate, in developing managed care strategies and plans for the hospital. This position will support cultural diversity by ensuring that the delivery of quality, equitable and culturally competent patient-centered care is provided; promoting and maintaining an inclusive work environment and culture that is respectful and accepting of diversity; and ensuring that cultural diversity and sensitivity training is part of new employee orientation on an on-going basis to meet the needs of the patient population served in the hospital.
License and Certification:
- Must be qualified to independently complete an assessment within the scope of practice of his/her discipline (for example, RN, SW, OT, PT, ST, and Rehabilitation Counseling).
- If licensure is required for his/her discipline within his/her state, individual must hold an active license.
- Current CCM® or ACM certification is required or must be obtained within one year of being placed in the position.
Education, Training and Years of Experience:
- For Nursing, must possess baccalaureate degree in Nursing (BSN) with RN licensure.
- For other eligible health care professionals, must possess a minimum of a baccalaureate degree and graduate degree is preferred.
- 3 years of hospital based Case Management experience including Utilization Review and Discharge Planning experience.
Machines, Equipment Used:
- General office equipment such as telephone, copy machine, fax machine, calculator, computer
- Good visual acuity and ability to communicate.
- Ability to lift, lower, push, pull, and retrieve objects weighing a minimum of 30 pounds. Reasonable assistance may be requested when lifting, pushing, and/or pulling are undertaken which exceeds these minimum requirements.
- Adheres to the company's Standards of Business Conduct.
- Maintains current licensure and/or certifications, if applicable
Skills and Abilities:
- Strong leadership skills.
- Strong negotiation skills.
- Must have a working knowledge of regulations and contractual obligations and parameters of third-party reimbursement.
- Must demonstrate skill in administrative functions of accountability, decision-making and time management, in addition to providing direct case management services to patients.
- Ability to speak, read, write, and communicate effectively.
- Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner.
- Ability to work independently without supervision.
- Indoor, temperature controlled, smoke-free environment. Occasional outdoor exposure
- Exposure or potential exposure to blood and body fluids may be required
- Handicapped accessible
- May work under stressful circumstances at times
Proficiency or Productivity Standards:
- Meets established attendance standards.
- Adheres to hospital/department dress code including wearing ID badge.
- May be required to work weekdays and/or weekends, evenings and or night shifts if needed to meet deadlines.
- May be required to work on religious and/or legal holidays on scheduled days/shifts.
- Will be required to work as necessary during disaster situations, i.e., before, during or after a disaster.
- May be required to stay after workday to assist after a disaster situation until relief arrives.
- May be required to perform other duties as assigned by supervisor.