Position Overview:
- The Director of Case Management plans, organizes, implements, and directs care coordination activities at Piedmont Medical Center.
- He/she is responsible for providing oversight and broad direction to case management, which includes care coordination, utilization review, social services, and discharge planning.
- The Director of Case Management works closely with the medical staff and Piedmont Medical Center leadership to identify patient care trends and issues.
- The Director develops care management programs, procedures, and clinical pathways that ensure efficient use of medical resources and provide optimum cost effective, quality care.
Responsibilities:
- Manage department operations to assure effective throughput and reimbursement for services provided.
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement.
- Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's policy.
- Ensure timely and effective patient transition and planning to support efficient patient throughput.
- Implement and monitor processes to prevent payer disputes.
- Develop and provide physician education and feedback on hospital utilization.
- Participate in management of post-acute provider network.
- Ensure compliance with state and federal regulations and TJC accreditation standards and other duties as assigned.
Desired Experience, Education, Licenses, and Certifications:
- Minimum Education: BSN or LMSW required, MSN preferred, willing to pursue Masters.
- Minimum Experience: Five to seven years of experience with utilization review, clinical pathways, case management, and disease management are required. Supervisory experience is preferred.
- Required: 3 years of acute hospital case management or healthcare leadership experience
- Preferred: 5 years of acute hospital case management leadership multi-site experience
- This position requires proficiency in working with medical statistics and data, including databases.
- Experience with medical statistical process and control procedures is required.
- Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
- Preferred: Accredited Case Manager (ACM)
- The Director of Case Management must possess excellent written and verbal communication skills and demonstrate the ability to prepare statistical data and report for formal presentations.
- The Director of Case Management must effectively interact with individuals who possess diverse personalities and levels of professional expertise.
Physical Demands:
- Lift/position up to 25 lbs.
- Push/pull up to 25 lbs. of force.
- Frequent sitting.
- Moderate standing, walking, reaching, stooping, and bending.
- Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.
Job Type: Full-time
Benefits:
- Dental insurance
- Health insurance
- Paid time off
- Relocation assistance
Schedule:
- Day shift
- Monday to Friday
License/Certification:
- Case Management Certification (Preferred)
- Registered Nurse or LCSW/LMSW license (Required)
Ability to Commute:
Ability to Relocate:
- Charlotte, NC: Relocate with an employer provided relocation package (Required)
Work Location: In person