Director of Case Management & Utilization Review
RN Degree in Nursing or a related field required. Excellent knowledge of Medicare and Medi-Cal regulations, utilization review and discharge planning criteria and processes, JCAHO, Title XXII, Federal and State regulations, legal aspects of utilization review and discharge planning and knowledge of community resources or how to access these resources.
Outstanding written and verbal communication skills. The ability to deal with a wide variety of people tactfully, effectively, objectively in problematic situations. Demonstrated ability in managing personnel in different physical locations and dealing with medical professionals and patients. Good organizational, analytical skills, creativity, and the ability to set work priorities are essential.
Recent in-depth and progressive acute hospital experience in utilization review, discharge planning, and management experience is required.
Certified in Utilization Review and Case Management preferred.
The incumbent oversees the activities and functions of the Case Management and Care Coordination Department to ensure efficient and cost-effective case management is achieved. The Director takes an active roll in ensuring that the department functions productively through the implementation of high level systems that ensure effective admission, continued stay monitoring, and timely discharge planning. The incumbent also ensures smooth resolution of problematic situations occurring in all functional areas involving patients, families, physicians, skilled nursing facilities, and other external agencies. The Director acts as a resource / liaison individual who provides interpretation, expertise and advice regarding case management issues for patients as well as legal, Federal and State regulations affecting the Case Management/Care Coordination Department.