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The Director of Case Management is responsible for the oversight of Case Management unit, including but not limited to clinical resource management, discharge planning activities, patient advocacy, clinical social work and best practice in medical necessity determination and concurrent review. Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and adherence to a designated Geometric Length of Stay (GLOS) for each patient.

Essential Functions:

The Director is responsible for the overall direction and management of these areas, including planning, organizing and directing all activities, staffing, performance improvement in the delivery of clinical services (such as LOS reduction), and reporting needs within the RRHS, as well as government and regulatory reporting.

The Director guides Care Coordination activities according to the needs, requirements, and policies of RRHS, the affiliated medical groups and health plans, and any Federal and State agencies, and according to standard practices of the professions under the director's accountability.

The Director will consult and collaborate with other managers, physicians, administration, and community based healthcare workers regarding care management issues identified through corportate or facility initiatives and current literature.

This position will work closely with all departments at the medical center and the post-acute service providers to streamline the patient transition through the health care system and into the community post discharge.

The Director participates regularly in RRHS, Service Area, or Corporate meetings pertinent to the accountable areas, and also participates in corporate strategic planning and performance improvement teams and programs as necessary.

This position requires the full understanding and active participation in fulfilling the Mission of the Organization. It is expected the director will demonstrate behavior consistent with the Core Values of the organization. It is expected the director will support the Organization's strategic plan and the goals and direction of the Performance Improvement Plan (PIP).

Assists with developing specific departmental goals, standards, and objectives which directly support the strategic plan and vision of the organization.

Assesses the quality of patient care delivered and coordinates patient care services with patients, staff, physicians, and other departments.

Creates and fosters an environment that encourages professional growth.

Integrates evidence-based practices into operations and clinical protocols.

Works with physicians, nurses, ancillary staff and social services at the point of care to facilitate multi-disciplinary decision-making that is consistent with the goals and objectives of the plan of care and the wishes of both the patient and family.

Must understand payer issues with regard to patient management and resulting implications of clinical decisions and anticipate to opportunities to reduce expense and capture revenue appropriately from admission through discharge.

Educates Physicians and staff in Case Management standards and assists them in meeting the regulations and standards as requested by Joint Commission, OSHA, CMS, HCFA, AHCA and other regulatory agencies. Educates and mentors all staff in UR standards and LOS topics.

Insures effective Utilization Review Process.

In addition, this position considers the population served by RRHS and area clinical integration programs and leads efforts to optimize care coordination across the care continuum. This coordination ensures a plan of care for patients in all states of health needs.

Minimum Education

Associate's Degree in Nursing requiredBachelor's Degree in Nursing or Master's Degree in related field preferred.

Current RN license to practice in NC (NC licensure or multi-state (compact) license).

Required Skills

Certifications:BLS required

ACMA Certification Preferred

CCM Certification completion within 1st year of employment or transfer to the role.

Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Comprehensive knowledge of care management and discharge planning, Medicare and Medicaid admission and review requirements, and general commercial admission and review requirements.

Working knowledge of Interqual criteria.

Working knowledge of finance and budgetary process, and government billing regulations.

Effective communication skills, especially with medical staff.

Knowledge of Conditions of Participation and Joint Commission standards.

Excellent customer service and presentation skills are a must

Strong interpersonal and written communication skills are essential

Demonstrated ability to apply analytical and problem solving skills

Demonstrated ability to manage multiple tasks or projects effectively

Ability to work independently as needed with a high degree of detail orientation

Capable of planning and organizing projects with short noticeAbility to work efficiently in a fast-paced environment

Minimum Work Experience

Minimum 3 years RN experience (acute care) and or Care Coordination experience required.

Minimum 3 years management experience preferred.

Required Citizenship / Work Permit / Visa Status
Must be a US Citizen

Must-Haves
Associate's Degree in Nursing required
BLS Certification required
Current RN license to practice in NC (NC licensure or multi-state (compact) license).
CCM Certification completion within 1st year of employment or transfer to the role.