Director of Case Management

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

Directs the Case Management and Utilization Management activities in a Scion Health hospital. Oversees the facilitation of care coordination of the patient and family through the management of quality clinical service delivery. Partners with external customers, referral sources and payors to ensure the facilitation and coordination of the discharge planning process and serve as the patient and family advocate. Accountable for the facility’s denial management program. Ensures that case management services comply with the Conditions of Participation. Collaborates closely with the hospital CEO/Administrator, COO, CFO, CCO and Region Office. 

Essential Functions

• Oversees coordination of patient care to facilitate development, monitoring and refinement of treatment plan
• Assumes responsibility for ongoing effective operations of the Case Management Department
• Ensures regular, complete and timely reporting of case management performance outcomes
• Represents and promotes Scion Health Hospitals to the provider community and to local educational institutions when appropriate
• Implements and monitors process to assure optimal utilization of resources and reimbursement
• Participates as a management team member in the Utilization Management Committee and serves on other committees as required and requested
• Identifies opportunities to achieve hospital goals based on available comparative data and benchmarks
• Aggregates and analyzes hospital utilization services statistics and recommends corrective action, if required
• Ensures areas of responsibility are operating in compliance with CMS, state and JCAHO regulations and standards and with Scion Health policies, including documentation and record requirements
• Actively participates in surveys and audits

Knowledge/Skills/Abilities/Expectations

• Thorough knowledge of case management activities and requirements
• Experience managing a variety of case management models using an interdisciplinary team approach
• Ability to motivate and lead
• Excellent interpersonal, verbal and written skills in order to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers
• Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software
• Proficient in accreditation standards and compliance requirements
• Ability to demonstrate critical thinking, appropriate prioritization and time management skills
• Knowledge of government and non-government payor practices, regulations, standards and reimbursement
• Must read, write and speak fluent English
• Must have regular attendance
• Approximate percent of time required to travel: 5%
• Performs other related duties as assigned

Education

• Graduate of an accredited program required: RN or BSN preferred; or Masters in Social Work with licensure as required by state regulations

Licenses/Certifications

• Healthcare professional licensure required as Registered Nurse
• Certification in Case Management preferred

Experience

• Minimum 3 years' experience in Hospital Case Management