Job Description

The Director of Case Management is responsible for the direction of staff and fiscal resources of the entire hospital Care Management and Swing Program. Functions across the health care continuum, interfacing with professionals from multiple disciplines to facilitate the best possible outcomes in the most resource appropriate manner. Develops and maintains statistical information that demonstrates effective fiscal responsibility in allocation of hospital resources. Consistently demonstrates leadership skills that include team building, motivating staff with enthusiasm and compassion, effective communication skills, recruitment of staff, and responsible department budgeting. Appropriately performs Case Management functions as needed. The Director of Case Management is responsible for completing all duties as assigned.

Education: Associates of Science degree required. BSN strongly preferred.

Experience: Minimum of five (5) years’ experience in care management in an acute care hospital and/or managed care setting required. Required Licensure/Certification(s): Current New Mexico RN or SW License required.

Must be familiar with federal and state accreditation standards as they relate to care management and utilization management.

-Responsible for the oversight, coordination, and daily operations of the Swing Bed Program. Ongoing oversight to include program development, community and patient education, program promotion, along with adherence to regulations.

-Monitor compliance with CMS Conditions of Participation, regulatory agency standards, insurance carrier requirements, and industry best practices.

-Advocate for patient's essential in this role including working knowledge of medical necessity criteria and understands insurance carriers coverage details. Effectively interact with insurance carriers and community healthcare resources.

-Ability to work in a stressful, fast-paced environment. Expected to lead and mentor team.

-Willingness to perform Care Management duties as needed.

-Practice in preparedness for Recovery Audit Contractors and Pay for Critical Access call requirements.

-Identify and resolve barriers that hinder efficient patient care.

-Maintains all required licenses and certifications. Submits updated verifications to Human Resources (HR) upon receipt of updated documentation.

-Actively upholds RMCHCS’ Mission, Vision and Core Values. Follows all policies and procedures.