Director of Case Management

Prime Healthcare; Northern (KY); Hybrid; USD 85,000 - 124,000; Full time

Job summary

Prime Healthcare is seeking a Director of Case Management (RN or LCSW) in a full-time, days shift. You will lead Case Management, Utilization Review, Social Work, Care Coordination, and Discharge Planning to optimize resources and patient outcomes.

Responsibilities include driving throughput, collaborating with physicians, payers, and interdisciplinary teams, and ensuring CMS and payer compliance. Minimum 5 years in case management with licensure in your state; MSW preferred.

Qualifications

• Licensed clinician in your state.
• Grandfathered prior to 1 April 2015; 5+ years post graduate in a social work program for LCSW.
• Minimum 5 years' experience in a Case Management role.
• Analytical ability for identifying problems and evaluating data.
• Basic to intermediate computer skills.

Responsibilities

• Lead Case Management, Social Work, Utilization Review, and Discharge Planning teams.
• Drive patient throughput, LOS, utilization management, readmissions, and denials prevention.
• Partner with physicians, nursing, payers, and interdisciplinary teams to remove barriers to care.
• Monitor performance metrics and lead quality and process improvements.
• Ensure CMS, accreditation, regulatory, and payer compliance.
• Collaborate to optimize resource use and discharge planning.

Skills

Licensed Clinician

RN or LCSW

Case Management

Data analysis

Computer skills

Analytical thinking

Education

MSW (Master of Social Work)

Job description

Overview

Director of Case Management RN or LCSWEmployment Status: Full-Time, Days, ExemptPay Range: $85,363 – $123,635 annually The Director of Case Management leads Case Management, Utilization Review, Social Work, Care Coordination, and Discharge Planning, driving effective resource utilization, patient throughput, quality outcomes, and regulatory compliance.

Responsibilities

• Lead Case Management, Social Work, Utilization Review, and
• Discharge Planning teams.
• Drive patient throughput, LOS, utilization management, readmission, and denial prevention strategies.
• Partner with physicians, nursing, payers, and interdisciplinary teams to remove barriers to care and discharge.
• Monitor performance metrics and lead quality and process improvement initiatives.
• Ensure compliance with CMS, accreditation, regulatory, and payer requirements.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

• Licensed clinician in your state.
• Grandfathered prior to April 1, 2015. Minimum 5 years’ post graduate of an accredited school of Social Work for Licensed Clinical Social Worker.
• Minimum 5 years’ experience in a Case Management position.
• Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an on-going review process.
• Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

• Certification in Case Management, BS or BSN or related field preferred.
• Current BCLS certificate preferred.
• Knowledge of Milliman Criteria and InterQual Criteria preferred.

Pay Transparency

Olympia Fields Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $85,363 to $123,635 annually. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

The company is dedicated to empowering its staff with a comprehensive, competitive benefits package, allowing them the freedom to customize their benefits to fit their unique needs. Our abundant resources, programs, and voluntary options serve as a foundation for individual growth and well-being. Learn more here: https://www.primehealthcare.com/benefitsthatmattermost/

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Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf