Responsibilities
The Director of Case Management directs, plans, supervises, integrates and coordinates the GVH Case Management and Clinical Documentation Improvement programs. Oversees Utilization Management, Denial Management, Care Coordination, DC Planning and Social Work in the acute care setting, as well as outpatient-related Case Management programs (ER, Healthy Beginnings, Medical Access Program, Outpatient Social Work). The Director of Case Management oversees and is responsible for the performance of the Supervisor of Case Management, department staff, department functions and outcomes. The Director of Case Management ensures organizational compliance with federal, state, payor and other entities for regulations and standards. Identifies, builds and directs strategic interventions and innovation to improve department, systems and organizational resource utilization to maximize quality of care transitions, clinical documentation and care coordination across the continuum while optimizing and securing revenue.
Qualifications
EDUCATION AND EXPERIENCE:Master's of Social Work:
- Master's degree from CSWE-accredited school of social work.
- Minimum of 5 years of progressively responsible hospital management positions related to case management is required.
- Working knowledge of managed care, care coordination, case management, social work, utilization management and clinical documentation improvement in an acute care setting is required.
- Sound knowledge of regulations and requirements for payors and federal, state and other entities is required required, or Associate's degree or diploma.
RN:
- Minimum of 5 years of progressively responsible hospital management positions related to case management is required.
- Working knowledge of managed care, care coordination, case management, social work, utilization management and clinical documentation improvement in an acute care setting is required.
- Sound knowledge of regulations and requirements for payors and federal, state and other entities is required.
BSN and Over 3 to 5 Years:
- Minimum of 5 years of progressively responsible hospital management positions related to case management is required.
- Working knowledge of managed care, care coordination, case management, social work, utilization management and clinical documentation improvement in an acute care setting is required.
- Sound knowledge of regulations and requirements for payors and federal, state and other entities is required.
Master's Degree in a Related Healthcare Field:
- Minimum of 5 years of progressively responsible hospital management positions related to case management is required.
- Working knowledge of managed care, care coordination, case management, social work, utilization management and clinical documentation improvement in an acute care setting is required.
- Sound knowledge of regulations and requirements for payors and federal, state and other entities is required.
LICENSES AND CERTIFICATIONS:
- Registered Nurse in PA – licensed or Clinical Social Worker – licensed.
BENEFITS:
- Medical, free dental, vision insurance for full time and part time
- 403B
- Pension plan
- On-site discounted child care center
- Tuition reimbursement up to $5250 per year
- Free life insurance
- Free parking
- Paid time off
- Sick time
- Flexible spending accounts
- Employee referral bonus
