Case Management Director oversees a staff of case managers responsible for patient care coordination. Develops and implements case management programs, including utilization review, intake or discharge planning, and managed care contracting or negotiation. Being a Case Management Director evaluates patient care data to ensure that care is provided in accordance with clinical guidelines and organizational standards. Seeks treatments that balance clinical and financial concerns with the family's needs and the patient's quality of life. Additionally, Case Management Director contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care. Typically requires a bachelor's degree. Typically reports to top management. May require Registered Nurse (RN). The Case Management Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Case Management Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
The Director of Case Management and Social Services is responsible for overseeing the activities of the department staff, optimizing quality, productivity, functional excellence and efficiency to accomplish strategic and operational objectives.
This position is an integrated, inter-professional role which supports caregivers to provide the highest quality, most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources.
This position also facilitates training and ensuring that monitoring and operations initiatives are implemented which secure compliance with ethical and legal business practices and accreditation/regulatory/government regulations.
The Director of Case Management and Social Services effectively and efficiently manages a diverse workload in a fast paced, rapidly-changing regulatory environment. The Director leads and provides support to the hospitals Utilization Review (UR) committee. He/she collaborates with multiple leaders at various levels of the organization.
The Director has well developed knowledge and skills in areas of Utilization Management (UM) medical necessity, and patient status determination and is responsible for performing a variety of concurrent and retrospective UM related reviews and functions for ensuring that the appropriate data is tracked, evaluated and reported.
Minimum Licensure
Valid State of Idaho Registered Nurse license or temporary RN license. Should obtain permanent license within 90 days. Compact license acceptable according to current Board of Nursing requirements.
American Nursing Credentialing Center (ANCC)-recognized certification
ACM (Accredited Case Manager) through AMCA (American Case Management Association) (preferred)
CCM (Certified Case Manager) CCMC (Commission for Case Manager Certification) (preferred)
Required Skills
Excellent interpersonal communication, problem-solving, and conflict resolution skills
Computer skills in word processing, data base management, and spreadsheets
Knowledge in areas of: Medicare and Medicaid UM regulations, McKesson InterQual, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management
Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
Ability to use appropriate interpersonal styles and techniques to gain acceptance of ideas or plans; modifying one's own behavior to accommodate tasks, situations and individuals involved
Ability to identify and understand issues, problems and opportunities, comparing data from different sources to draw conclusions; using effective approaches for choosing a course of action or developing appropriate solutions; taking action that is consistent with available facts, constraints and probable consequences
Extensive knowledge of regulatory and accreditation agency requirements that impact department; stays abreast of industry changes
Capable of leading teams/facilitating groups, building consensus and garnering highest confidence in professionalism and work product by senior leadership
Organizational Expectations
Provides a positive and professional representation of the organization.
Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.
Maintains hospital standards for a clean and quiet environment.
Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.
Participates in ongoing quality improvement activities.
Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.
Complies with organizational and regulatory policies for handling confidential information.
Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in The Gritman Way.
Population Served
Neonate, pediatric, adolescent, adult and geriatric, all genders, races, ethnicities, sociopolitical, demographic, marital, and sexual preference groups, developmental and physical abilities, mental illness, religions, and nationalities.
Physical Demands
Prolonged, extensive or considerable standing/walking. Considerable reaching, stooping, bending, kneeling, and crouching. Must possess good manual and finger dexterity. Visual requirements include near and far acuity, depth perception, color differentiation, and focusing ability. Hearing, speech, and sense of touch essential. Occasional repetitive motion activities.
Environmental Conditions
Regularly exposed to the risk of blood borne disease and other infectious disease. Contact with patients under a wide variety of circumstances, including their home environment. May be exposed to/occasionally exposed to patient elements, i.e., accidents, injuries, and illnesses. Subject to varying and unpredictable situations; potentially violent or angry patients and families; emergencies and crisis situations. Occasionally subjected to irregular hours/shifts. Frequently required to function competently with multiple demands and tasks. Maybe exposed to environmental hazards in patient homes. May be exposed to noxious and potentially hazardous fumes.