The Director-Case Management works collaboratively with the Assistant Vice President (AVP) Care Coordination to direct and oversee the day-to-day functions of case management services across three hospital sites under LLUMC licensed inpatient and outpatient areas. Develops, implements, and maintains a comprehensive and fiscally sound case management program and orchestrates cohesive patient-centered care practices which address the needs of the patients from admission through discharge and across the continuum of care. Establishes and maintains processes to oversee case management onsite reviewers from payer insurances/organizations. Maintains a positive working relationship with payers and keeps each payer informed of changes during in-patient stay, discharge plan, and resources needed for safe and timely discharge. Performs other duties as needed.
Education and Experience:
Master of Science Degree in Nursing required, or, Bachelor of Science Degree in Nursing and a Master of Science Degree in healthcare, finance, or education required. Minimum four years nursing experience which has provided opportunity to demonstrate competencies in case management, clinical nursing, leadership, administration, or education required.
Knowledge and Skills:
Substantial knowledge of case management practice, state and federal healthcare regulations, finance, performance improvement, quality, patient safety, evidenced-based clinical practice standards, medical staff structure and legal aspects of care required. Knowledge of adult learning principles, management and problem-solving methodologies. Exhibits professional behavior at all times. Able to speak, read and write legibly in English (and Spanish preferred) with professional quality; use computer, printer, and software programs necessary to the position, e.g., Word, Excel, Outlook, PowerPoint, electronic medical record, electronic event reporting program; relate and communicate positively, effectively, and professionally with others; be assertive and consistent in following and/or enforcing policies; work calmly and respond courteously when under pressure; lead, supervise, teach, and collaborate; accept direction; think critically; use sound judgment based on factual information and clinical knowledge; work independently with minimal supervision; meet deadlines; perform basic math and statistical functions; manage multiple assignments effectively; organize and prioritize workload; problem solve in a proactive and creative manner; recall information with accuracy; pay close attention to detail; hear sufficiently for general conversation in person and on the telephone; identify and distinguish various sounds associated with the work place; see adequately to read computer screens, medical records, and written documents necessary to position.
Licensures and Certifications:
Active California Registered Nurse Licensure required. Basic Life Support Certification from the American Heart Association required. Case Management Certification preferred.
