Registered NurseDirector of Case Management
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Job Location:
Cranston, RI - USA
Monthly Salary:
Not Disclosed
Posted on:
17 hours ago
Vacancies:
1 Vacancy
Job Summary
BHDDH is expanding their Case Management Program at Eleanor Slater Hospital. The Director of Hospital Case Management will provide strategic leadership and operational
oversight for all case management and utilization review functions within a state-operated long-term acute care hospital. This role ensures the delivery of appropriate cost-effective high-quality care while maintaining compliance with regulatory and payer requirements across the continuum of care.
Key Responsibilities
- Participate in daily interdisciplinary care rounds collaborating with physicians nursing social work and ancillary services to evaluate develop and implement case management plans
- Serve as a liaison with the Patient Resources and Benefits Division
- Identify high-risk patients and coordinate targeted interventions with the healthcare team
- Gather and analyze clinical information using established criteria guidelines policies and clinical judgment to support coverage determinations
- Provide coordinated care support to facilitate and expedite patient services
- Communicate post-hospital recommendations and collaborate with Social Work to support timely and safe discharge planning
- Develop and maintain patient care reports to ensure effective handoffs during transitions of care
- Coordinate length-of-stay management with providers patients and families including education on insurance qualifiers impacting discharge
- Advocate for patients regarding financial implications related to discharge planning
- Oversee insurance pre-authorizations for inpatient services continued stays post- acute placement and ancillary services
- Ensure timely submission of clinical documentation and compliance with payer- specific requirements
- Collaborate with payers and internal stakeholders to resolve authorization denials and conduct peer-to-peer reviews as needed
- Identify opportunities to improve patient flow and reduce delays in care delivery
- Participate in departmental and interdepartmental quality improvement initiatives
- Ensure operations align with organizational standards and regulatory requirements
- Maintain compliance with federal state and local case management regulations
Required and Preferred Skills (Please show on resume)
-
- BSN from an accredited nursing program
- Current RN license to practice in the State of Rhode Island
- Certification by a recognized national organization in case management is preferred
- 3 years of clinical case management experience preferred
- Utilization management experience including demonstrated experience obtaining insurance pre-authorizations and managing payer authorization processes across the continuum of care
Work Location:
This position will work onsite at both Eleanor Slater Hospital locations including the Cranston Campus (Cranston RI) and the Zambarano Unit (Pascoag RI).
Interview Location:
Interviews will be conducted in person at the BHDDH administrative offices Barry Hall 14 Harrington Road Cranston RI.
Assignment Lenth: At least 1 year but most likely longer with good chance to convert to FTE
Client Name: RI BHDDH
Position: Onsite
