Director, Case Management & Care Coordination

Med-Metrix; New York (NY); On-site; USD 130,000 - 170,000; Full time

Job summary

Med-Metrix seeks a Director of Case Management to lead and evaluate case management services, oversee utilization management, care coordination, and transition management within a Hospital setting. Responsible for strategic initiatives aligning with mission, regulatory requirements, and performance indicators.

The role requires extensive nursing leadership experience, NY state RN licensure, and strong CMS, HIPAA, and regulatory knowledge, with a focus on improving outcomes and revenue

Qualifications

• Bachelor's Degree in Nursing is required; Master’s Degree preferred.
• Minimum of five to ten years acute care clinical experience.
• Minimum of five years case management leadership experience.
• New York State Licensed Registered Professional Nurse.
• Certification in Hospital Management strongly preferred.
• Certification in Case Management, PRI and Screen.
• Broad knowledge of medical, nursing and allied health sciences and revenue cycle.

Responsibilities

• Direct case management and social work activities to monitor quality of care and compliance with standards.
• Address and resolve patient/family and staff satisfaction issues.
• Identify and intervene on LOS issues.
• Develop and evaluate case management for high risk/high volume patients.
• Implement and evaluate concurrent utilization review practices.
• Effectively manage concurrent denials.
• Utilize data to improve department activities and performance.
• Collaborate with other leaders to integrate Case Management/Social Work across the continuum.
• Monitor and maintain regulatory readiness (JCAHO, federal and state).
• Identify and manage clinical revenue enhancement projects.
• Assist with staff development and affiliating students.
• Participate in policy formulation and revision.

Skills

Nursing leadership

Case management

CMS knowledge

HIPAA compliance

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing or related field

Job description

Med-Metrix seeks a Director of Case Management to lead and evaluate case management services, oversee utilization management, care coordination, and transition management within a Hospital setting. Responsible for strategic initiatives aligning with mission, regulatory requirements, and performance indicators.

The role requires extensive nursing leadership experience, NY state RN licensure, and strong CMS, HIPAA, and regulatory knowledge, with a focus on improving outcomes and revenue