Director of Case Management-Acute


: $62,916.67 - $146,770.00 /year *

Employment Type

: Full-Time


: Executive Management

To succeed in our high-energy, high-reward environment, our clinicians provide compassionate critical care and deliver exceptional patient experiences , meaningful outcomes, and bonds for life. As our most acute level of care, Kindred's transitional care hospitals offer the same critical care patients receive in a traditional hospital or intensive care unit , but for an extended recovery period. Our clinicians play a vital role in the recovery process for chronic, critically ill and medically complex patients . As a Director Case Management, you will : Develop and implement the philosophies, policies, procedures and goals for the Case Management Department. Train and develop the Case Management staff and motivate them to accomplish department goals and objectives. Develop and oversee the annual Case Management budget. Prepare and evaluate monthly, quarterly and annual reports of the Department's functions. Provide information regarding changes in Medicare regulations and documentation issues to physicians and others as needed. Maintain Prospective Payment System, monthly case log and other files needed for peer review organization and specific needs of the hospital. Analyze physician utilization patterns, comparing to national and individual hospital standards. Communicate findings to Utilization Review and other appropriate individuals. Discuss denial of coverage related to Utilization Review with the Director of Quality Management. Assist with on-site monitoring reviews by PRO, Blue Cross, outside review organizations and third-party payers. Maintain a working relationship with local, state and federal agencies, recognizing the hospital's position in the community and its need for cooperation and assistance from such services As a Director Case Management, you will have: Bachelor's degree in clinical area required. Bachelor of Science in Nursing preferred. Equivalent combination of education, training, and experience may substitute for education requirements. Healthcare professional licensure required as Registered Nurse, Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW). Appropriate certification in Case Management preferred; for example, Commission for Case Manager Certification (CCMC); Association of Rehabilitation Nurses (ARN) certification. Minimum three years experience in Hospital Case Management.

Job Requirements:
  • Participate in case management committees and work on special projects related to case management
  • Staffing as a case manager
  • Review internal case management processes and procedures
  • Foster case management at an organizational level
  • Provide meaningful direction on management of case files
  • Direct and monitor the case and utilization management
  • Implement, and oversee case management policies and procedures
  • Provide case direction and supervision to field case specialists when on-site intervention be required
  • Explain case manager role and process to contact case manager for questions, guidance and education
  • Performing UR, case management and discharge functions
  • Develop and implements case management cost of care initiatives that ensure patient quality of care and decrease medical utilization
  • Ensure the efficient and effective performance of all utilization, case and care management operations
  • Provide hospital leadership for operations and management of the case management staff and department
  • Participate and monitor potential vendor services for disability case management or long term care assessments
  • Provide leadership to ensure seamless integrated member care within Care Services as well as other departments by involving inpatient case management with out-patient case management and utilization management
  • Coordinate the patient care, discharge, and home planning processes with Humana case managers and hospital case management departments, and other healthcare facilities
  • Alleviating current gaps in care management programs
  • Participate in integrated team care management rounds
  • Oversee the planning and progress of operational issues relating to medical case management
  • Provide departmental education designed to enhance knowledge and performance of case management responsibilities

Associated topics: administrative officer, assist, asso, document, facilities, front desk, operational support, records management, staff, support * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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