Director, Case Management & Care Coordination

RiseMe

New York (NY)

On-site

USD 120,000 - 180,000

Full time

4 days ago

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Job summary

RiseMe seeks a seasoned Director of Case Management to lead the administration, direction and evaluation of Case Management services in a hospital setting. You will drive utilization review, care coordination and transition management while aligning with strategic goals and regulatory requirements.

Ideal candidates will have RN licensure in New York, 5–10 years of acute care experience, and leadership in case management with CMS knowledge.

Qualifications

Bachelor’s Degree in Nursing required; advanced degree preferred
New York State Licensed Registered Nurse
Certification in Case Management and PRI/Screen strongly preferred
Minimum 5–10 years acute care clinical experience
Minimum 5 years case management leadership experience
Strong knowledge of CMS Conditions of Participation related to utilization management

Responsibilities

Direct case management and social work activities to monitor quality of care
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 department leaders to integrate Case Management across the continuum
Monitor regulatory readiness (JCAHO, federal and state)
Identify and manage clinical revenue enhancement projects
Assist with staff learning experiences and training
Maintain and update policies for case management
Communicate policy changes to staff
Ensure PHI handling complies with HIPAA