Insurance and Risk Management Director jobs in Montgomery, AL

Case Management Director II

Sign on Bonus $10,000. 00
As a member of Senior Leadership, the
Director of Case Management (DCM)
is responsible for the day to day operations and human resource management of the department of Case Management. With a central focus on census management, patient care outcomes, and key care indicators, the DCM oversees the interdisciplinary plan of care and the discharge planning process to ensure the effectiveness and appropriateness of services. The DCM is a patient and family advocate to ensure that services are delivered to meet the needs of patients and their families, and that the utilization of resources is appropriate.
RESPONSIBILITIES AND TASKS
Performs all duties and responsibilities of a Case Manager during case management services.
Assigns patient caseload to department members and self for optimal service delivery.
Coordinates/communicates effectively with administration, medical staff, and interdisciplinary team.
Participates, as appropriate, in developing managed care strategies and plans for the hospital.
Consults on service delivery, financial management, and discharge planning processes.
Oversees team conference process and educates staff in facilitation and reporting.
Leads daily case management operations meetings.
Represents department in hospital operations.
Analyzes reports from systems such as PATCOM, UDS, and Press Ganey.
Implements- and educates case managers on- effective continuum of care and community resources.
Provides appropriate training, education, and management to the department of Case Management.
Trains Case Managers on managing caseloads and interpreting regulations, policies, operational procedures and objectives.
Reviews operations in assigned area to ensure a high level of quality that is consistent with organizational standards.
Completes special projects and other duties as requested to support needs of organization.
Coordinates and participates in hospital utilization review process.
Performs case management analysis.
Oversees concurrent review functions with appropriate follow-up action plan and intervention.
Ensures compliance with CMS regulations and Conditions of Participations for discharge planning.
Manages core staffing plan and employs flexible staffing plan as necessary.
Builds relationships as defined through targeted goals of the business plan.
Networks with insurance companies, self-insured employers, case management firms, and/or other health care networks.
Acts as a resource for case managers and other team members.
Coordinates with other department managers to direct quality of care delivery.
Completes mandatory training and courses required by completion date.
Participates in administrative on-call schedule and coordinates case management on-call schedule.
Qualifications
License or 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 available for the discipline within the hospital's state, individual must hold an active license.
Current CCM® or ACM certification is required or must have obtained within one year of being placed in the position.
Minimum Qualifications:
For Nursing, must possess bachelor's degree in Nursing (BSN) with RN licensure.
For other eligible health care professionals, must possess a minimum of a bachelor's degree; graduate degree is preferred.
3 years of hospital-based Case Management experience including Utilization Review and Discharge Planning experience.