Director of Case Management

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Director of Case Management | Tulsa, OK

Job Summary

The Director of Case Management plans, organizes and directs case management activities. Responsible for providing oversight and broad direction to case management, including utilization review, social services, and discharge planning. The Director of Case Management works closely with clinical staff and medical staff to ensure that patients are classified in the appropriate level of care, to monitor the patient during their hospitalization, and to ensure an appropriate patient length of stay with a discharge plan to ensure the high-quality patient outcome.

Essential Functions and Responsibilities

  • Develops and implements policies, procedures, and goals for Case Management. Promotes a positive environment by setting an atmosphere of open communication and feedback. Considers & communicates feedback to / from consumers / personnel, initiates corrective action when indicated.
  • Trains, asses, and mentors case management staff regarding resource consumption, the level of care appropriateness, denial management, and complex continuum of care needs, re-certifications or alternate cost effective levels of care, variance tracking and outcomes measuring. Conducts criteria based performance appraisals at regularly scheduled intervals. Counsel’s employees appropriately, demonstrating sound motivational techniques aimed at enhancing staff performance.
  • Provides information regarding changes in Medicare regulations and documentation issues to physicians and others as needed.
  • Leads initiatives to identify relevant essential statistical data requirements to support the development and implementation of clinical protocols, pre-printed order sets, utilization review, case management and other similar case coordination duties.
  • Develops and implements the organization’s utilization management plan in accordance with the mission and strategic goals of the organization. Federal and state law, regulations, and accreditation standards.
  • Compiles reports, analyzes data and identifies significant trends in medical utilization data such as lengths of stay, re-admissions, and clinical outcomes. Actively participated and prepares and presents summaries to the Utilization Review Committee identifying potential areas of improvement.
  • Develops and oversees the annual Case Management budget. Collaborates with the Information Services department to develop and implement information services technologies to support/enhance care management activities.

Education

  • Bachelors of Science Degree in Nursing (BSN) from a state-approved registered nursing program Masters of Science in Nursing (MSN) preferred.
  • Licensure, Registration and/or Certification
  • The Valid State of Oklahoma Registered Nurse License.

Work Experience

5-7 years related experience including experience with medical statistical process and control procedures is required. Computer skills with knowledge of Excel and Word. Familiarity with InterQual and Milliman USA criteria.

Knowledge, skills, and Abilities

  • Must show evidence of competent clinical knowledge and experience.
  • Must have excellent written and verbal skills.
  • Ability to evaluate and prioritize quality/utilization management data.
  • Must demonstrate the ability to effectively interact with medical staff, individuals who possess diverse personalities and levels of professional expertise.

Decision Making

Independent judgment in making decisions from many diversified alternatives that are subject to general review in final stages only.

Working Relationships

  • Direct supervision of others – 10-15 direct reports.
  • Prepares and gives performance evaluations.
  • Works with internal customers via telephone or face to face interaction.
  • Works with external customers via telephone or face to face interaction.
  • Works with other healthcare professionals and staff.
  • Works frequently with individuals at Director level or above.

Job Type: Full-time

Salary: $105,000.00 /year

Required experience:

  • Medial statistical process and control procedures: 5 years

Required license or certification:

  • Registered Nurse

Required education:

  • Bachelors