This dynamic leader utilizes a systems approach in planning,
creating strategies, developing programs that address case
management functions across the transitions of care, and directing
the activities of the Integrated Case Management department. The
Director develops, implements, coordinates and monitors the
hospital's case management, utilization management, discharge
planning and social work functions to assure current best practice
standards and compliance with Federal, State and regulatory agency
requirements. The Director works collaboratively to provide
consultation and assistance regarding medical, social, legal and
ethical situations needing intervention. The Director possesses
knowledge in key functions of revenue cycle, denial management and
related payer contract requirements. The Director manages,
organizes, and co-facilitates the UR Committee with the Medical
Director of Integrated Case Management per the UR Plan and the
Conditions of Participation. The Director sets the tone and models
positive leadership behavior in support of staff, and towards
achieving department and organizational goals. In addition to
building relationships with internal stakeholders, this leader will
develop partnerships with post-acute facilities and agencies to
meet the needs of SMH patient population.
- Require a Bachelors degree in nursing, clinical or business
area, or in health care administration.
- Require a minimum of seven (7) years of experience in case
management, care coordination and utilization management with a
minimum of three (3) to five (5) years of progressive leadership
and management experience preferably in a director role in a
Masters degree in related clinical or business area, or in health
- Prefer active membership in
professional organizations and relevant professional certifications
(i.e., CCM, CMAC, or ACM).
- Prefer demonstrated ability to interact
and interface with all levels of staff, senior management and
members of the medical staff.
- Prefer demonstrated ability to work
independently and in groups toward established
- Prefer demonstrated effective
leadership, critical thinking, decision making and problem solving
- Prefer demonstrated excellent oral,
written communication and presentation skills, including
proficiency in Microsoft Office programs.
- Prefer demonstrated
working knowledge of utilization management and the application of
evidenced based clinical care guidelines.
- Prefer sound working knowledge of
relevant CMS Rules and Regulations, Joint Commission standards and
State and Payer requirements.
- Prefer strong data analytical and
management reporting skills.