Case Management Director - RN or LCSW

20 Northeast Georgia Medical Center, Inc.; Gainesville (FL); On-site; USD 90,000 - 140,000; Full time

Job summary

Northeast Georgia Health System is seeking an experienced executive leader to coordinate case management and social work services across the NGHS system. The role focuses on integration, education, and process improvements to enhance patient outcomes and optimize resource use.

Responsibilities include leading IDTs, managing LOS initiatives, collaborating with providers, and ensuring compliance with healthcare regulations while driving financial performance.

Qualifications

• Commensurate with professional requirements, CCM/ACM exam within 2 years, and current RN or LCSW licensure.
• Bachelor’s Degree required; Master’s Degree required if Social Work candidate.
• Minimum 5+ years in hospital clinical/financial operations and management.
• Experience in Case Management components: Discharge Planning, Clinical Social Work or prior Case Manager.
• Experience with third party payers and physicians.

Responsibilities

• Coordinates integrated case management and social work from systems perspective.
• Leads development/education of the case management function across NGHS.
• Participates in LOS initiatives and IDTs to improve patient outcomes.
• Manages contract negotiations, budgeted staffing, and staff performance.
• Analyzes data to drive clinical process improvements and financial performance.

Skills

Leadership

Communication

Problem solving

Change management

Education

Bachelor's Degree

Master's Degree (Social Work or related)

RN licensure or LCSW; CCM/ACM exam within 2 years

Job description

Job Category: Executive Leadership, Nursing - Registered Nurse Work Shift/Schedule: 8 Hr Morning - Afternoon

Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

About the Role:

Job Summary Coordinates the development and implementation of case management and social work services with an emphasis of vertical integration throughout the Northeast Georgia Health System delivery system.

Minimum Job Qualifications

• Licensure or other certifications: Commensurate with professional requirements, successful completion of ACM or CCM exam within 2 years, and currently licensed as a RN or LCSW.
• Educational Requirements: Bachelor’s Degree required, Master Degree required if Social Work candidate.
• Minimum Experience: Five (5) or more years experience in hospital clinical/financial operations and management.
• Experience in at least one major component of Case Management, i.e. Discharge Planning, Clinical Social Work; previous Case Manager.
• Experience working with third party payers and Physicians.
• Other: Preferred Job Qualifications Preferred Licensure or other certifications: Preferred Educational Requirements: Masters Degree preferred, i.e., Nursing, Business Health, Management, Leadership, Case Management, etc within 3 years if RN.
• Preferred Experience: Experience in healthcare Federal and State regulations.
• Other: Job Specific and Unique Knowledge, Skills and Abilities Knowledgeable in operational design, assertiveness/persuasiveness, effective written/verbal communication, and ability to effect change. Possesses positive relationship building, flexibility, problem solving, organizational skills, analytical skills, high level of emotional intelligence, and vision Must have knowledge of healthcare funding resources, patient services and clinical standards and outcomes

Preferred Job Qualifications

• Preferred Licensure or other certifications: Preferred Educational Requirements: Masters Degree preferred, i.e., Nursing, Business Health, Management, Leadership, Case Management, etc within 3 years if RN.
• Preferred Experience: Experience in healthcare Federal and State regulations.
• Other: Job Specific and Unique Knowledge, Skills and Abilities Knowledgeable in operational design, assertiveness/persuasiveness, effective written/verbal communication, and ability to effect change. Possesses positive relationship building, flexibility, problem solving, organizational skills, analytical skills, high level of emotional intelligence, and vision Must have knowledge of healthcare funding resources, patient services and clinical standards and outcomes

Essential Tasks and Responsibilities

Coordinates the operational design and collaborates to ensure an integrated case management and social work function. Develops and coordinates the implementation of the case management function from a systems perspective promoting an interdisciplinary collaborative proactive environment. Coordinates the development and implementation of case management education. Identifies opportunities and makes recommendations to improve NGHS services and to enhance continuum options. Works closely with senior management and the multi-disciplinary team to manage the delivery of patient services within given time frames, to decrease the length of stay for inpatient care, to ensure effective and prudent use of resources, and to improve care continuity and patient outcomes. Participates in length of stay system initiatives and is an active member of all LOS steering committees. This position is ultimately accountable for ensuring case management duties are fulfilled during IDTs (Interdisciplinary Team Meetings) and must round regularly and participate in IDTs to improve system Length of Stay. Works closely with Providers to better manage the process for admission, concurrent patient management, discharge and post discharge activities. Evaluates program structure and processes on a continuous basis to adapt program design to meet the demands of a changing healthcare system and organizational objectives. Provides for systematic patient management through effective use of NGHS continuum and maintains organizational responsibility for access control. Works with Providers to coordinate, develop and implement clinical process improvements. Works with Directors of Operations and Quality Improvement to analyze data for the purpose of identifying opportunities for clinical process improvements. Participates with Providers and NGMC internal staff to develop, implement and monitor the effectiveness of clinical pathways. Works with senior administration to resolve operational issues that are barriers to clinical process improvement endeavors. Participates in MRUR (Medical Record/Utilization Review Committee), including performing and updating on medical/clinical case studies. Explores opportunities and makes recommendations for organizational standards. Responsible for components of and strives to enhance/maintain NGHS financial performance improvement. Maintains accountability for timely pre-certification for Post Acute services and minimizes the organizational financial risk for penalty. Provides case-by-case contract negotiations for the organization, where indicated. Responsible for acute inpatient social work functions. Effectively and efficiently manages Case Management Department. Hires appropriate budgeted positions and assures proper training. Conducts regular, informative meetings with staff and responds to their needs. Performs performance appraisals in a timely and open manner. Maintains professional work ethics within the department and assures maximum staff productivity. Provides staff counseling and disciplinary action as necessary and/or required. Assesses departmental workload and determines appropriate staff allocations. Coordinates, monitors and manages outcome data to measure clinical and financial performance. Works closely with Providers and staff to provide, interrupt and monitor clinical/financial data for the purpose of improving hospital/Physician performance and anticipating payer and managed care demands. Maintains responsibility for tracking and reporting avoidable day. Demonstrates sensitivity to customer service data and develops appropriate strategies for response as indicated.

Physical Demands

Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

Vision: Moderate, Frequently 31-65% of time

Kneeling/Stooping/Bending: Occasionally 0-30% Standing/Walking: Frequently 31-65% Pushing/Pulling: Occasionally 0-30% Intensity of Work: Occasionally 0-30%

Job Requires

Reading, Writing, Reasoning, Talking, Keyboarding, Driving Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals. NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status. Northeast Georgia Health System (NGHS) is a non-profit on a mission of improving the health of our community in all we do. Our team cares for more than 1 million people across the region through five hospitals and a variety of outpatient locations. Northeast Georgia Medical Center (NGMC) has campuses in Gainesville, Braselton, Winder, Dahlonega and Demorest – with a total of more than 850 beds and more than 1,200 medical staff members representing more than 60 specialties. Learn more at www.nghs.com.