Director of Care Management

Job Summary: The Case Management Supervisor oversees a team of case managers responsible for coordinating patient care across various stages of the care continuum. This role involves developing and implementing case management programs, including utilization review, intake or discharge planning, and managed care contracting or negotiation. The supervisor evaluates patient care data to ensure that care is aligned with clinical guidelines and organizational standards, balancing clinical and financial considerations with the needs of patients and their families. This position requires extensive experience and judgment to effectively plan and accomplish goals while providing leadership and direction to a team.

Key Responsibilities:

• Lead and supervise a team of case managers in the coordination of patient care, ensuring effective planning, delivery, and follow-up.
• Develop and implement case management programs, including utilization review, discharge planning, and managed care negotiations.
• Evaluate patient care data and outcomes to ensure adherence to clinical guidelines, regulatory requirements, and organizational standards.
• Balance clinical needs with financial considerations and family preferences to enhance patient quality of life and improve care outcomes.
• Provide strategic oversight and guidance in patient care decisions, ensuring that all processes align with organizational goals.
• Mentor and develop case management staff, providing support, training, and performance evaluations.
• Collaborate with multidisciplinary teams, including physicians, social workers, and other healthcare professionals, to ensure comprehensive care planning.
• Review and approve care plans, ensuring compliance with applicable regulations and standards.
• Contribute to the development of policies and procedures related to case management and patient care coordination.
• Ensure appropriate documentation and reporting of case management activities and patient progress.
• Engage in regular communication with senior leadership to report on case management outcomes, challenges, and opportunities for improvement.

Qualifications:

• Registered Nurse (RN) certification required.
• Minimum of 7-10 years of clinical nursing experience, with at least 3-5 years in case management or a related healthcare leadership role.
• Strong knowledge of case management principles, utilization review, managed care processes, and discharge planning.
• Proven ability to balance clinical decision-making with financial considerations and patient/family needs.
• Excellent leadership, communication, and interpersonal skills.
• Ability to manage multiple priorities and work in a fast-paced environment.
• Familiarity with healthcare regulations, standards, and accreditation requirements.
• Strong analytical and problem-solving skills with the ability to make sound clinical and business decisions.

Work Environment: This position typically reports to top management and requires a high degree of creativity, initiative, and problem-solving ability. The role may involve leading and directing the work of others, with a wide degree of latitude in decision-making.