Director, Case Management

•  With a focus on reducing length of stay, minimizing readmissions and appropriate level of care assignment - establishes, implements, evaluates, and communicates a strategic plan for the department that takes into account internal and external factors.  

• Creates data priorities and report formats that display critical outcome factors, and reviews findings with the Executive Team.  

• Establishes appropriate staffing levels, assignments, and deployment for the department.  

• Establishes job descriptions and performance criteria for staff members.  

• Identifies organizational needs and concerns in payer-provider contracts and contributes to related negotiations.  

• Establishes effective relationships with individual physicians, physician groups, and physician organizational structures.  

• 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.  

• Develops, leads, and implements an effective outcomes management process.  

• Establishes effective relationships with external agencies providing services to the organization (such as vendors, care providers, etc.).  

• Evaluates and optimizes patient satisfaction with discharge planning functions.  

• Supports utilization review activities for the hospital, interfacing with the BMC Main campus utilization review program, external payers and review companies to support determination of appropriate medical necessity of admissions and continued hospitalization.  

• Resolves conflicts related to discharge planning with patients/families, external agencies, and payers.  

• Facilitates transition of patients/families across the continuum by establishing relationships with appropriate post-acute providers and community services.  

• Provides leadership to multidisciplinary groups as organized by the facility.  

• On an annual basis, develops measurable, reasonable, and market-oriented goals for the department that reflect those of BMC-South and the Case Management department.  

• Establishes policies, procedures, and protocols for departmental functions.  

• In collaboration with BMC Main campus, assists with insuring that the Utilization Management process is current.  

• Ensures that the Discharge Planning process is current.  

• Creates processes to anticipate and address specific situations within the department, including long-stay patients, post-acute resource referral lists, denials, and termination of benefits.  

• Identifies improvement opportunities within the department and at the system level.  

• Creates a system for initial and ongoing education and development of staff.  

• Ensures compliance with The Joint Commission standards and CMS rules and regulations. 

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required) 

JOB REQUIREMENTS 

PREFERRED EDUCATION AND EXPERIENCE:

CERTIFICATIONS, LICENSES, REGISTRATIONS REQUIRED:

• N/A 

KNOWLEDGE, SKILLS & ABILITIES (KSAs):

• Knowledge of external requirements that impact the department, such as The Joint Commission and Department of Health.  

• Knowledge of information systems to support the evaluation of current capacity as well as future needs.  

• Extensive knowledge and comfort with Interqual criteria