Director of Case Management

MedStar Health; Baltimore (MD); On-site; USD 80,000 - 143,000; Full time

Job summary

MedStar Health is seeking a seasoned leader to direct Utilization Case Management and Discharge Planning. You will oversee psychosocial assessment, discharge planning, and interdepartmental collaboration to optimize patient flow and outcomes.

The role requires RN licensure in MD or DC and a CCM preference within 90 days, with a strong emphasis on compliance, quality, and efficient care transitions across the hospital system.

Qualifications

• Master's degree in Nursing (MSN), Healthcare Administration, Business Administration or related field.
• 3-4 years progressive leadership experience; CM/SW/UR experience required.
• RN licensure in MD or DC; CCM certification preferred within 90 days.

Responsibilities

• Develops and achieves department goals while ensuring compliance with policies, quality, safety and regulations.
• Manages department budget and allocates resources.
• Selects, trains, orients and assigns department staff; evaluates performance and supports development.
• Develops and revises clinical pathways, procedures and guidelines at hospital and system levels.
• Coordinates patient transitions across departments to ensure timely, cost-effective discharge planning.
• Leads social work services including psychosocial assessment, counseling, crisis intervention, and discharge planning.
• Monitors length of stay and resource utilization; reports on LOS, discharges, outcomes and denials.

Skills

Leadership

Communication

Problem solving

Collaboration

Analytics

Education

Master's degree in Nursing (MSN) / Healthcare Administration / Business Administration or related field

Job description

General Summary of Position

Plans organizes coordinates and directs the Utilization Case Management and Discharge Planning Programs. Monitors discharge planning services and counseling to patients and their families and consultation to medical staff regarding patient management.

About The Job

Plans organizes coordinates and directs the Utilization Case Management and Discharge Planning Programs. Monitors discharge planning services and counseling to patients and their families and consultation to medical staff regarding patient management.

Primary Duties And Responsibilities

• Develops and contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Ensures compliance with hospital/facility policies and procedures and governmental/accreditation regulations.
• Develops and recommends department operating budget and manages resources according to approved budget.
• Selects trains orients and assigns department staff. Delegates tasks as appropriate. Develops standards of performance evaluates performance and conducts performance management planning. Identifies individual staff development needs and provides appropriate resources to meet needs. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with subordinates to review programs provide feedback discuss new developments and exchange information.
• Contributes to the development review revision and implementation of clinical pathways procedures and guidelines at the hospital and system level.
• Coordinates the facilitation of patient transition from area to area in a timely cost effective manner. Assures that the hospital-based program encompasses preadmission emergency room admitting acute care discharge follow-up sub-acute and rehabilitation.
• Directs and participates in the provision of social services in the areas of psychosocial assessment and counseling crisis intervention child abuse home health care oncology and other support groups' discharge planning.
• Ensures the delivery of quality care to inpatients and outpatients by identifying patient needs and developing social service programs to meet those needs.
• Monitors and evaluates the effectiveness of policies and practices with regard to length of stay and utilization of resources.
• Oversees monthly monitoring and reporting of critical data on LOS discharges clinical and teaching outcomes denials overturned denials and other reports.
• Provides direction and support regarding Utilization Management Case Management Discharge Planning and Social Work.
• Serves as the hospital liaison to payers in matters pertaining to utilization of acute care services. Makes recommendations regarding third party case management contracts.
• Participates in meetings and on committees and represents the department and business unit in community outreach efforts. Participates in multidisciplinary quality and service improvement teams and maintains effective working relationships with other departments.

Minimal Qualifications

Education

• Master's degree in Nursing (MSN) Healthcare Administration Business Administration or related field required

Experience

• 3-4 years 4 years progressive leadership preferred and
• Experience in CM/SW/UR required

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the State of Maryland or District of Columbia Upon Hire required and
• CCM - Certified Case Manager within 90 Days preferred

Knowledge Skills And Abilities

• Excellent problem-solving skills and ability to exercise independent judgment.
• Business acumen and leadership skills.
• Strong verbal and written communication skills with ability to effectively interact with all levels of management internal departments and external agencies.
• Working knowledge of various computer software applications preferred.

This position has a hiring range of

USD $58.03 - USD $104.12 /Hr.