(Only QUALIFIED Healthcare Professionals accepted) Case Manager-RN – Dir – Case Mgmt – CHMC Utilization Management
The Director of Case Management leads and manages the day-to-day operations of utilization, clinical resource and case management departments and focuses on the continuum of care for the patient population.
Develops case management programs that allows the hospital(s) to meet clinical resource management goals as well as third party and regulatory standards.
Manges and educates staff at all levels about effective clinical resource management. Provides formal and informal programs.
Maintains effective working relationships and effectively communicates the goals and objectives of the program to the medical staff, department staff, and others within and outside the hospital.
Evaluates the effectiveness of existing clinical protocols and pathways and makes recommendations for new ones.
Promotes organizational mission statement and goals and empowers staff and peers to achieve outstanding performance.
Effectively reports departmental activities, goals, and measures of success.
Works effectively with MCO staff and leadership to decrease denials or downgrades in reimbursement.
Maintains department standards for regulatory and accreditation purposes.
Actively seeks to resolve those issues brought forward by medical staff that have an adverse effect on patient outcomes.
Analyzes the issues for cost|benefit in terms of improving clinical and financial outcomes.
Prioritizes and recommends effective approaches that will improve clinical and financial outcomes in the hospital.
Primary liaison between Case Management and the hospital Quality Committee.
Recommends plans of care for high profile DRGs that incorporate effective Case Management strategies.
At least 3+ years Nursing Management experience in an acute care setting required
Hospital Case Management experience required
Managed Care Organization (MCO) experience preferred
Licensed clinician in your state.
Minimum 5 years experience in a Case Management position required
Behavioral Violence Prevention Training within 3 months of hire and maintain current
Bachelor of Science in Nursing (BSN) required, Certification in Case Management
Masters Degree in Nursing or a related healthcare field preferred
Registered Nurse License required
Certified Case Manager (CCM) a plus, not required
Healthcare Quality of Utilization Review (HQUR) a plus, not required
Current BCLS (AHA) certificate preferred
Knowledge of Milliman Criteria and InterQual Criteria preferred
Advanced communication and interpersonal skills
Analytical and quantitative analysis skills
Ability to lead a complex department to reach and exceed goals
Ability to work with other departments
Knowledge of Managed care trends, Medicare and Medicaid regulations