Serves as the Director of Case Management responsible for implementing and supervising the day-to-day operation of the Case Management.  Manages activities necessary to ensure appropriate utilization of the Hospital and its resources while maintaining optimal achievable standards of patient care.  Maintains the strictest confidentiality of all patient information.

Promotes the concept of cooperation and develops open lines of communication with department employees, patients, visitors and other personnel within and outside the Hospital. The Case Management Director will direct the individual functions in accordance with legislative, regulatory and accrediting guidelines.

1. Oversees the daily operation of the Case Management Department.
2. Assists in the assessment of anticipated impact of external regulations and cost-containment efforts related to Case Management.
3. Oversees Case Management activities.
4. Responsible for providing a framework to effectively manage a patient's care from onset of illness to return to health (or stabilization of illness) across the continuum of care.
5. Collaborates with Finance, Clinical Services and Medical Staff to maintain a system of documentation that accurately reflects patient care and resources applied to meet clinical outcomes.
6. Collects, analyzes, evaluates and monitors data to achieve program goals.
7. Responsible for department’s operational excellence; assures department delivers quality services in accordance with applicable policies, procedures and professional standards.
8. Manages human resources to assure quality services and promote positive employee relations.
9. Responsible for the fiscal management of department; assures proper utilization of organization’s financial resources.
10. Effectively communicates departmental, organization and industry information to staff.
11. Attains all agreed to goals and objectives within specified timeframes, as part of the organization’s overall mission.
12. Attends all required Safety Training programs and can describe his/her responsibilities related to general safety, department/service safety, specific job‑related hazards.
13. Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.
14. Promotes effective working relations and works effectively as part of a department/unit team inter and intra departmentally to facilitate the department's/unit's ability to meet its goals and objectives.
15. Provides coverage to the Director of Utilization Review for vacation, sick, LOA time, etc.

Minimum Education

• Registered nurse graduated from an accredited school of nursing with a license to practice professional nursing in this state.
• Bachelor's degree in Health Care–related field strongly preferred.
• Master's degree in Nursing, Health Care Administration, Public Health, Business Administration, preferred.
• Working knowledge of Federal, State and regulatory requirements in quality assessment, case management, resource management, hospital systems, accreditation, and licensure is desired.

Minimum Work Experience

• Five years of relevant progressive work experience in clinical healthcare, including direct experience in quality assessment and resource management preferred.
• Strong professional, organizational, and interpersonal skills required for effective and creative leadership in working with all levels of the Organization including physicians, committees, senior management, and trustees, as well as patients and their families.
• Ability to lead, support and build on current efforts of various groups working within the department's scope of work.
• Ability to extensively communicate with outside agencies, third-party payers and regulators.
• Prior management experience in hospital-wide quality resource management programs, monitoring and evaluation, experience in ensuring compliance with Federal and State regulations and statutes relating to healthcare delivery.
• Possess good analytical and problem-solving skills. Ability to work with computerized clinical information systems.  Initiative, flexibility, integrity and diplomacy is desirable.
• Function independently under the guidance of the CCNO within the broad scope of department and organization-wide policies, practices and common goals.
• Generally refers specific problems to CCNO only when the clarification of operating policies and procedures may be required.