The Dir, Case Management is responsible for implementation and administration of the Case Management Program. Case Management focus is on the Care Coordination of patient care and utilization management of the hospital's resources for this care. Priority efforts are directed toward building and maintaining consistency in the case management model and outcomes through the use of appropriate leading practice methods while adapting to the ever-changing compliance and regulatory requirements which prevail in the healthcare industry.

The incumbent will support a responsive case management model that includes, but is not limited to: case management assessment, care coordination, and discharge planning. Additionally, the incumbent is to be well versed with regards to contractual and compliance requirements of third-party payors, evidence-based practice models and clinical documentation improvement programs all of which are to promote the efficient and effective use of resources while providing the best possible patient outcomes while supporting patient safety, quality management and process improvement efforts. The incumbent will direct, plan and coordinate all inpatient hospital utilization review and case management activities which are inherent of a leading practice model of case management. The incumbent is expected to work closely with all internal functional departments, representatives of third-party payors and community agencies to provide quality patient outcomes while managing medical resources effectively.

 Key Responsibilities include:

1. Ensure that timely and effective discharge and transition needs assessment and plans are complete, safe and appropriate.
2. Plan, direct and ensure hospital case management services and functions which include: admission and concurrent review. Management of the exceptions, denial and appeal process, coordination with finance in the adjudication of claims for services managed, provide education to patients and providers, ensure this performed in accordance with internal and external guidelines, regulations, policies, and procedures.
3. Plan and ensure that utilization and case management activities receive the necessary information from the managed care systems and information management staff to effectively monitor their status with regards to health system goals and objectives.
4. Creates an environment in which each Associate can develop to his/her fullest capacity.
5. Through leadership and example, ensure that Associates understand their roles and how they contribute to the Case Management Department and Health System objectives
6. Lead and direct the growth and development of continuous improvement activities through inter-functional and multidisciplinary teams that will increase job satisfaction and company profitability.
7. Promote and ensure ongoing management and leadership accountability for inter-functional teams to include responsibility for ensuring team's progress towards goals. Evaluate achievement through Associate satisfaction surveys and staff turnover rates.
8. Oversee the planning, development and control (through reporting of budget variances) of the hospital utilization and case management budget.
9. Ensure regular, complete and timely reporting of information regarding the functioning of hospital utilization, case management and throughput.

• Bachelor's degree required, Master's preferred, Case Management certification preferred.
• Demonstrated hands-on leadership and operational responsibility in a large/complex healthcare environment with 5+ years' experience of successful management experience and in-depth understanding of managed care, experience in budgeting and strategic planning of goals and objective.
• Thorough knowledge of managed care utilization and quality management activities and requirements.
• Experience in healthcare compliance management
• Experience managing a variety of case management models using an interdisciplinary team approach.
• Understands financial impact of efficient resource management.
• Ability to hire, train and coach associates.
• Demonstrate understanding of competency-based criteria for case management.
• Ability to manage a complex, multiple hospital case management program