Director Case Management and Care Transition

Director of Case Management
Memphis TN

The Director of Case Management also leads the Transitions of Care program for specific patient populations transitioning from inpatient to outpatient care. The RN Director of Case Management oversees daily team activities and provides strong leadership through training coaching teaching and managing assigned teams The Director of Case Management leads a collaborative Case Management effort by coordinating the care and services of patient populations. The Director provides clinical leadership for the Care Management team by serving as an educator role model patient advocate and change agent to achieve optimal clinical financial and resource outcomes.

Qualifications:

• RN required
• MSN required
• Director of Case Management experience in an Acute Hospital setting required
• Certifications in Case Management or Utilization Management preferred
• Onsite only

Responsibilities:

Case Management:

• Provides clinical guidance and supervision to all Case Management programs based on accepted principles of Nursing Social Work and Case Management practices
• Provides leadership to the interdisciplinary team (RNs APNs Social Workers Utilization Review) to achieve optimal outcomes through the tools of Care Management
• Collaborates with stakeholders to continually streamline standardize and systematically implement best practice Case Management processes including interfaces with Revenue Cycle
• Develops and implements Case Management programs including utilization review intake and discharge planning
• Manages and monitors department activities to evaluate the productivity and quality of programs and processes to identify potential improvements and ensure maximum performance
• Develops and administers budgets for operational areas authorizes expenditures and monitors budget and other financial indicators
• Assists in the development and implementation of plans to control costs and improve department operations
• Develops and maintains professional networks and relationships with hospitals physicians community resources and other providers to promote continuity and quality of care
• Uses a collaborative approach with physicians and the multidisciplinary team to facilitate care and eliminate barriers for the designated case load
• Ensures that the plan of care and services provided are patient focused high quality efficient and cost effective
• Seeks care plans that balance clinical and financial concerns with the familys needs and the patients quality of life
• Uses data to drive decisions and plan/implement improvement strategies for assigned patients including fiscal clinical and patient satisfaction data
• Initiates and leads the development implementation evaluation and revision of clinical pathways
• Ensures that policies and procedures are developed and enforced in alignment with standards of patient care and regulatory bodies and that the core components of Case Management processes are followed
• Works in collaboration with other key stakeholders to remain current on regulatory requirements
• Participates in the development of standardized processes to fulfill compliance with all CMS and regulatory agencies statutes/standards specific to Utilization Management
• Monitors Associates performance and clarifies work expectations assists with goal setting and promotes cooperation among individuals and groups
• Develops and implements processes through orientation training and education to ensure that the competence of all staff members is assessed maintained improved and demonstrated throughout their employment

Revenue Cycle:

• Serves as a resource to the corporate and facility Revenue Cycle teams as well as Corporate Compliance for any/all denials including all pre and post pay audits related to Utilization Management
• Serves as an active participant in the appeals process
• Improves Care Transitions for complex patients to reduce readmission rates impacting reimbursement

Care Transition:

• Directs the Transitions of Care program to coordinate and meet the complex needs of patients with chronic conditions and/or specific populations as they transition from hospital to home or different levels of care
• Creates and oversees a highquality program to focus on Care Transitions which include comprehensive discharge planning timely communication of information between care providers patient/caregiver education medication reconciliation and followup visits
• Identifies specific readmission risks and targets riskspecific interventions to identify barriers to discharge reduce length of stay and readmission rates

Additional Knowledge:

• Working knowledge of discharge planning Utilization Management Case Management performance improvement and managed care reimbursement
• Strong understanding of preacute and postacute venues of care and postacute community resources
• Demonstrates advanced conflict resolution and problemsolving skills for timely resolution
• Demonstrated ability to develop and maintain working relationships with physicians and work collaboratively with health professionals at all levels to achieve established goals
• Knowledge of quality improvement tools and metrics to assess and manage case management goals
• Understanding of regulatory/compliance requirements such as UM/URAC and CMS conditions of participation

For our Case Management opportunities feel free to forward a resume to Michelle Boeckmann at or visit our Case Management website at this opportunity is of interest or know someone that would have interest please feel free to contact me at your earliest convenience.

Michelle Boeckmann President Case Management Recruitment
Direct Dial




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