Summary
The Director of Case Management and Social Work (CMSW) provides strategic and operational leadership to ensure high-quality patient-centered care that responsibly serves both the community and the organization. This role is instrumental in advancing equitable access to care supporting vulnerable populations and strengthening partnerships across the care continuum to reduce preventable readmissions and improve health outcomes.
As a high functioningleader the Director oversees all daily operations of the Case Management and Social Work departments fostering a collaborative high-performing team culture built on accountability professional development and compassionate service. The Director recruits mentors and manages department staff while promoting interdisciplinary collaboration with medical nursing HIM and senior leadership teams.
With a strong focus on fiscal responsibility the Director drives effective resource utilization to reduce length of stay and cost per case without compromising quality of care. Through data-driven decision-making and utilization management the role ensures responsible stewardship of organizational and community resources.
The Director serves as the critical link between clinical documentation compliance and reimbursement working closely with the HIM department and providers to ensure accurate physician documentation that reflects severity of illness and complexity of care. Deep knowledge of CMS regulations and Conditions of Participation is essential to maintaining compliance and supporting sustainable operations.
Responsibilities:
- Provides supervision and guidance to Case Management (CM) staff scheduling performance management training and accurate and concise documentation. The director plays a critical role in team building and support of front line staff.
- Leadership of Complex Case Meetings and Monitors Interdisciplinary Rounds (IDRs) -Plays an active role co-chairing IDR work group. Collaborates with nursing to ensure the work group is meeting at minimum monthly to report and review audit scores identify opportunities for improvement and develop and implement action plans to improve IDR processes and outcomes.
- Performs Audits of Case Management Staff Assessments Reviews and Documentation Assists with regulatory compliance and risk management
- Maintain an Active Role in Denials and Appeals Verifies staff comprehension and utilization of HINNs MOON IMM and other required payer/government noticesand escalates concerns to Physician Advisor COO/CNO and/or CFO as appropriate
Requirements:
- A Bachelors degree is required.
- Bachelors in nursing or Social Workan Active New York State RN Licensure and BS or BSN Degree preferred. Masters Degree in a related field is preferred.
- Candidates must have a minimum of five (5) years leadership experience in Case Management Utilization Management and Quality Assessment or a minimum of five (5) years leadership experience in a related field acute care experience strongly preferred.
- Eligible for or certified in Case Management is desirable.
- Extensive knowledge of all CMS regulations and conditions of participation is essential.
Ellis Medicine is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to and will prohibit discrimination on the basis of race creed color religion sex/gender (including pregnancy) age national origin disability (including pregnancy-related conditions) genetic information predisposition or carrier status military or veteran status prior arrest or conviction record marital or familial status sexual orientation transgender status gender identity gender expression reproductive health decisions domestic violence victim status known relationship or association with any member of a protected class and any other characteristic protected by applicable law violates federal state and where applicable local laws reproductive health decisions or source of payment consistent with applicable legislation and to comply with the laws pertaining thereto.
Salary Range: $41.30-$61.94 /hourPay is based on experience skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Required Experience:
Director
Summary The Director of Case Management and Social Work (CMSW) provides strategic and operational leadership to ensure high-quality patient-centered care that responsibly serves both the community and the organization. This role is instrumental in advancing equitable access to care supporting vulne...
Summary
The Director of Case Management and Social Work (CMSW) provides strategic and operational leadership to ensure high-quality patient-centered care that responsibly serves both the community and the organization. This role is instrumental in advancing equitable access to care supporting vulnerable populations and strengthening partnerships across the care continuum to reduce preventable readmissions and improve health outcomes.
As a high functioningleader the Director oversees all daily operations of the Case Management and Social Work departments fostering a collaborative high-performing team culture built on accountability professional development and compassionate service. The Director recruits mentors and manages department staff while promoting interdisciplinary collaboration with medical nursing HIM and senior leadership teams.
With a strong focus on fiscal responsibility the Director drives effective resource utilization to reduce length of stay and cost per case without compromising quality of care. Through data-driven decision-making and utilization management the role ensures responsible stewardship of organizational and community resources.
The Director serves as the critical link between clinical documentation compliance and reimbursement working closely with the HIM department and providers to ensure accurate physician documentation that reflects severity of illness and complexity of care. Deep knowledge of CMS regulations and Conditions of Participation is essential to maintaining compliance and supporting sustainable operations.
Responsibilities:
- Provides supervision and guidance to Case Management (CM) staff scheduling performance management training and accurate and concise documentation. The director plays a critical role in team building and support of front line staff.
- Leadership of Complex Case Meetings and Monitors Interdisciplinary Rounds (IDRs) -Plays an active role co-chairing IDR work group. Collaborates with nursing to ensure the work group is meeting at minimum monthly to report and review audit scores identify opportunities for improvement and develop and implement action plans to improve IDR processes and outcomes.
- Performs Audits of Case Management Staff Assessments Reviews and Documentation Assists with regulatory compliance and risk management
- Maintain an Active Role in Denials and Appeals Verifies staff comprehension and utilization of HINNs MOON IMM and other required payer/government noticesand escalates concerns to Physician Advisor COO/CNO and/or CFO as appropriate
Requirements:
- A Bachelors degree is required.
- Bachelors in nursing or Social Workan Active New York State RN Licensure and BS or BSN Degree preferred. Masters Degree in a related field is preferred.
- Candidates must have a minimum of five (5) years leadership experience in Case Management Utilization Management and Quality Assessment or a minimum of five (5) years leadership experience in a related field acute care experience strongly preferred.
- Eligible for or certified in Case Management is desirable.
- Extensive knowledge of all CMS regulations and conditions of participation is essential.
Ellis Medicine is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to and will prohibit discrimination on the basis of race creed color religion sex/gender (including pregnancy) age national origin disability (including pregnancy-related conditions) genetic information predisposition or carrier status military or veteran status prior arrest or conviction record marital or familial status sexual orientation transgender status gender identity gender expression reproductive health decisions domestic violence victim status known relationship or association with any member of a protected class and any other characteristic protected by applicable law violates federal state and where applicable local laws reproductive health decisions or source of payment consistent with applicable legislation and to comply with the laws pertaining thereto.
Salary Range: $41.30-$61.94 /hourPay is based on experience skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Required Experience:
Director
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