RN Director of Case Management

RN Director of Case Management
Kansas City Missouri

The Director of Care Management is responsible for providing leadership strategic planning and oversight of daily operations of the Case Management department which includes Utilization Management Care Progression and Discharge Planning promoting interdisciplinary collaboration teamwork and championing service excellence. The Director of Care Management works under the strategic direction of the Senior Director of Care Management and responsibilities include appropriate and effective use of the department resources oversight of collection analysis and reporting of financial data quality improvement and performance improvement and ensuring compliance and accountability of all functions and services. The position will ensure consistency in workflows documentation quality and outcomes for Case Management across the health system.

Qualifications:

• Registered Nurse
• Masters Degree MSN or Masters Degree in Health Administration
• Director of Case Management experience in an Acute Hospital Setting
• ACM or CCM required within 3 years of hire

Responsibilities:

Strategic Leadership:

• Develops and implements outcome and in-process metrics for Care Management aligned with the organizations true North pillars
• Provides direction to achieve the goals and objectives based on metrics
• Develops and implements standard practices that represent best practice in patient status recommendations medical necessity review pre-bill denial avoidance and Denial Management
• Partners with Revenue Cycle Payor Relations HIM and Risk Management in support of Utilization Management and high-risk patients
• Creates accountability and escalation pathways for resolving Care Coordination and Care Progression barriers throughout the health system
• Accountable and responsible for length of stay and resource reduction strategies
• Recommends process improvement to maximize efficiency and cost effectiveness
• Contributes as a partner with Senior Leadership as healthcare subject matter expert
  Acts as liaison to facilitate communication and collaboration between all care partners (internal and external partners etc.)
• Establish relationships with payors to promote Continuum of Care alignment and strategies
• Facilitates development of trusting relationships and partnerships with physicians nursing payers patients and coworkers
• Utilizes knowledge of hospital processes clinical patient care state and federal regulations and payer requirements to participate and guide leadership of interdisciplinary teams towards improvement of patient flow and patient progression clinical outcomes and efficiency of inpatient stays
• Continually strives to integrate Case Management and Social Work across the system
• Ensures that all Case Management processes and outcomes meet or exceed regulatory requirements
• Direct and oversees the activities of all work groups and task forces that are structured to drive projects and improvements for Case Management

Performance Improvement and Workforce Strategies

• Oversees and directs the work of Nurse Case Managers Social Workers and Utilization Review specialist team members and support staff
• Analyzes evaluates and recommends operational efficiencies process design and organizational structure that enables optimal Case Management and Utilization Management
• Objectively measures efficiencies productivity quality and cost performance to identify and track performance and use data to drive decisions
• Monitors and evaluates decisioning making by tracking and assessing overturned appeals physician decision trends related to level of care and status and denials data to coach to and make recommendations for improvement
• Provides consultations/direction to individuals and /or teams or committees to facilitate compliance
• Serves as catalyst for organization change to improve operational and clinical processes that impede patient progression toward optimal outcomes
• Utilizes high reliability principles and the lean operating system and tools to evaluate operations and problem solve
• Assures that departmental administrative functions are performed including team member performance evaluations and development
• Recruits interviews hires and on-boards new management staff
• Provides direction and evaluates departmental workload and responsibilities
• Collaborates effectively with Human Resource leaders
• Provides support and guidance to enhance staff and management development by providing education training coaching role modeling and mentoring

Fiscal and Resource Management

• Maintains accountability for meeting established financial performance metrics for assigned departments
• Works collaboratively with department leadership team to plan develop implement and monitor all financial activities of the department
• Responsible for approving and managing the day-to-day dept. operational budget
• Assures that revenue expenses and FTEs meet or exceed budget; prepares and submits budget and related reports
• Forecasts and accurately projects expenses; takes corrective action to address negative variances; identifies and proposes capital budget items appropriately
• Identifies and ensures appropriate resources to achieve department financial goals
• Participates in negotiations regarding adding or renewing medical necessity critical decision support tools and related software applications and implementations
• Engages in Utilization Review committee

How to Apply:

Interested candidates please submit your resume to Michelle Boeckmann at . Visit for more details and additional opportunities. Feel free to share these contact details with anyone interested in Case Management or Utilization Management roles.

Contact: Michelle Boeckmann President Case Management Recruitment
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Required Experience:

Director