Case Management Director

hace 1 semana


Madrid, Madrid, España Medcruit A tiempo completo

Job Summary

The Director of Case Management is responsible for leading the implementation of the case management program at the hospital level. This role involves overseeing the components of the inpatient case management program, including care facilitation, utilization management, case management, and discharge planning. The ideal candidate will have a strong background in case management and utilization review, with experience in supervising case managers and social workers. The Director will be responsible for providing leadership, education, and supervision to the team, as well as monitoring documentation to ensure regulatory compliance. Additionally, the Director will collaborate with the Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data. The successful candidate will have excellent communication skills and be able to work collaboratively with healthcare professionals to achieve established goals and improve quality outcomes.

Key Responsibilities

* Provide leadership, education, and supervision to case managers and social workers
* Monitor case management department documentation to ensure regulatory compliance
* Collaborate with Chief Financial Officer and Quality Department to develop and maintain quality improvement programs and trending of data
* Maintain skills in case management and utilization review to allow for coverage of patient caseload
* Communicate with physicians concerning patient needs and aid with the development of appropriate plans of treatment and assist with level of care and bed placement assignments
* Directly responsible for personnel actions including hiring, performance appraisals, employee schedules, and maintain payroll records and time reports in KRONOS
* Facilitate daily Multidisciplinary Rounds to provide collaboration with other disciplines to provide holistic patient care
* Participate in discharge planning
* Provide necessary education and resources to meet the discharge needs of individual patients and families
* Active participant of Utilization Review Committee and Revenue Recycle Committee
* Promote efficient utilization of clinical resources
* Promote the appropriate amount of resources used based on patient acuity
* Assure appropriate level of understanding, awareness, and compliance with all applicable Joint Commission, CMS, state and local agency laws, internal/external regulations, guidelines, policies, procedures, and professional standards

Requirements

* Working knowledge of payer requirements and discharge planning regulations that support the development of departmental policies, procedures, and standards
* Working knowledge of Medicare, managed care, inpatient, outpatient, and home health continuum, as well as utilization management, discharge planning, and case management
* Ability to work collaboratively with healthcare professionals at all levels to achieve established goals and improve quality outcomes
* Working knowledge of concepts associated with performance improvement
* Self-motivated, proven communication skills, assertive, able to work independently and as a team member
* Demonstrated effective working relationships with physicians
* Education: Graduate of a program of Registered Nursing
* Bachelor of Science in Nursing degree preferred
* Experience: Minimum of two years of Case Management experience in utilization management, case management, discharge planning, or other cost/quality management program
* Two to three years previous management experience is preferred with a minimum of two years' experience in hospital-based nursing
* Certification: Iowa Mandatory Reporter Child and Dependent Adult Abuse Certificates
* Current RN license in the state of Iowa or a multistate license allowing work in the state of Iowa


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