Director of Care Management - RN

Job Description

Benefits

• Competitive salary with a comprehensive benefits package, including:
  • 401(k) match
  • Paid Time Off (PTO)
  • Medical, dental, vision and flexible spending accounts
  • Life and disability insurance and more!

Job Summary 

The Director, Care Management is responsible for overseeing the implementation, development, and management of the Care Management and Resource Management programs. This position ensures compliance with all regulatory requirements, establishes efficient processes for patient care and discharge planning, and provides leadership to the Care Management team. The Director works collaboratively with staff, physicians, and community resources to deliver patient-centered care and achieve optimal outcomes. 

Essential Functions

• Oversees the implementation and maintenance of an effective and compliant Care Management program that meets all regulatory and accreditation standards.
• Provides leadership and direction to staff, ensuring accountability for duties and adherence to roles within their scope of practice.
• Conducts chart reviews to evaluate severity of illness (SI) and intensity of services (IS) for admissions, continued stays, and discharge planning.
• Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up.
• Identifies avoidable days and implements communication systems to address and resolve them effectively.
• Coordinates discharge planning and social services functions to ensure compliance with federal and state laws and Joint Commission standards.
• Acts as a liaison to community agencies, providing resources and services for post-hospital placement and support.
• Ensures accurate and timely reporting of CPS (Child Protective Services) or APS (Adult Protective Services) cases as mandated, and educates staff on mandatory reporting requirements.
• Interprets and enforces policies and regulations set by CMS, Joint Commission, and other governing bodies, ensuring department compliance.
• Participates actively in Patient Care Conferences and Length of Stay (LOS) meetings to support efficient care delivery and discharge planning.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• Bachelor's Degree in Nursing required
• Master's Degree in Nursing, Healthcare Administration, or a related field preferred
• 4-6 years of clinical nursing experience required
• 3-5 years of experience in care management or utilization review required
• 1-3 years of leadership experience in a healthcare setting required

Knowledge, Skills and Abilities

• In-depth knowledge of care management principles, discharge planning, and regulatory compliance requirements.
• Strong leadership and team-building skills to guide and motivate staff.
• Excellent communication and interpersonal skills to collaborate effectively with multidisciplinary teams and external partners.
• Analytical and problem-solving skills to address complex patient care and operational issues.
• Proficiency in electronic medical records (EMR) and care management software.
• Commitment to patient-centered care and continuous quality improvement.

Licenses and Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure required
• BCLS - Basic Life Support within seven (7) days of hire or transfer to position required