Director Case Management

POSITION SUMMARY

Responsible for the direction of staff and fiscal resources of the Case Management Dept. Oversight of the hospital Case Management program. Provides direction and planning for physician advisor, and staff to establish priorities identifying trends. Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources. Provides direction and planning for physician advisor, and staff to establish priorities identifying trends. Develop short- and long-term goals for cost containment and reduction of LOS and utilization of hospital resources. Develops structures and processes to facilitate participation by physicians, pharmacists, nurses, Social Workers and other health professionals in multidisciplinary care planning, care delivery, and discharge planning. Directs utilization review activities for the hospital, interfacing with external payers and review companies to determine appropriate medical necessity of admissions and continued hospitalization. Resolves conflicts related to discharge planning with patients/families, external agenand payers. Facilitates transition of patients/families across the continuum by establishing relationships with appropriate providers and community services Ensures compliance with DNV standards for the Continuity of Care function. Participates as a member of DNV Task Force. Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.) Effectively audits and monitors areas of responsibility for compliance issues. Promptly follows up on compliance issues. Creates an environment that encourages staff to report/resolve complicated issues. Employee is dependable and completes other assigned duties on schedule and these duties do not have to be redone.

QUALIFICATIONS

Must be a graduate of an Accredited School of Nursing with a current La State Board License RN Case Management experience in an acute care setting preferred. Previous supervisory experience preferred. A current Louisiana license is required. Computer skills preferred.