Director of Case Management
Job Posting for Director of Case Management at Virtus Healthcare Staffing
Job Title: Director of Case Management
Location: Detroit, MI
Summary
Trusted Staffe is partnering with a Level I trauma hospital in Detroit, MI, to identify a highly skilled and experienced Director of Case Management. This leadership position plays a critical role in overseeing the hospital's case management department, ensuring optimal patient care and resource utilization.
Responsibilities
Interested candidates are encouraged to submit their resumes to Trusted Staffe. We are committed to equal-opportunity employment and value diversity in the workplace.
Location: Detroit, MI
Summary
Trusted Staffe is partnering with a Level I trauma hospital in Detroit, MI, to identify a highly skilled and experienced Director of Case Management. This leadership position plays a critical role in overseeing the hospital's case management department, ensuring optimal patient care and resource utilization.
Responsibilities
- Staffing and Leadership:
- Maintain adequate staffing levels and skill mix to meet patient needs and departmental goals.
- Utilize industry-standard case management staffing recommendations and hospital budgetary guidelines for staffing requests.
- Conduct regular departmental meetings, provide updates, and offer ongoing education to staff.
- Complete initial and annual competency and evaluation reviews for all case management staff.
- Implement action plans for improvement based on InterQual Inter-rater Reliability (IRR) results.
- Utilization Management:
- Implement and monitor processes to ensure medical necessity reviews and appropriate patient status and level of care.
- Oversee timely referral and documentation of cases for Physician Advisor review.
- Implement and monitor utilization review processes to support admission, level of care, length of stay, and authorization for post-acute services.
- Advocate for patient and hospital interests with payers to secure appropriate reimbursement.
- Care Coordination:
- Collaborate with hospital leadership to ensure effective Patient Care Conferences and Complex Case Review processes.
- Participate in daily bed management meetings to optimize patient placement and transfers.
- Monitor patient care plans for clinical appropriateness, alignment with patient choice, and availability of resources.
- Ensure effective communication and collaboration among the healthcare team to achieve patient care goals.
- Provide education to physicians and staff regarding medical necessity, documentation, and compliance.
- Regulatory Compliance:
- Ensure compliance with federal, state, and local regulations and accreditation requirements related to case management.
- Ensure departmental structure, staffing, policies, and procedures align with CMS Conditions of Participation and industry best practices.
- Education:
- Graduate of an accredited school of Nursing.
- Bachelor's degree in Nursing or a health-related field, or equivalent experience.
- Master's degree in Nursing, Business Administration, or Hospital Administration preferred.
- Licensure:
- Licensed to practice as a Registered Nurse in the State of Michigan.
- Experience:
- Three to five years of acute hospital case management leadership experience.
- Five years of acute hospital case management experience is preferred.
- McKesson InterQual® experience preferred.
- Business planning experience preferred.
- Certifications:
- Accredited Case Manager (ACM) preferred.
- Skills:
- Strong analytical, fiscal, communication, interpersonal, teaching, and project management skills.
- Demonstrated leadership ability and comfort with decision-making responsibilities.
- Technical knowledge of community resources, regulatory requirements, reimbursements, and utilization management procedures.
Interested candidates are encouraged to submit their resumes to Trusted Staffe. We are committed to equal-opportunity employment and value diversity in the workplace.
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