Director, Case Management

Northern Westchester Hospital Forest Hills , NY 11375

Posted 4 months ago

Job Description:

Directs, plans, implements and evaluates all activities of the Case Management program. Oversees resource utilization for the hospital. Develops length of stay (LOS) and resource reduction strategies, capitalizing on facility best practice and providing specific LOS analysis and making recommendations for process improvement. Acts as a liaison to regulatory agencies to ensure compliance of requirements and to ensure third party payers reimbursement/coverage is approved to meet patients' level of care.

Responsibilities Include:
1.Directs, plans, implements and evaluates case management of patient care across the continuum of care.

  • Collaborates with other hospital Directors, establishes goals and objectives for the department.

  • Develops strategies and programs to achieve goals, as evidenced by positive quality clinical and administrative outcomes.

  • Develops and implements policies and procedures supporting quality patient driven care through efficient and effective case management.

  • Analyzes and evaluates effectiveness of patient care standards, policies and procedures to improve quality of patient care and plans utilization of staff resources and activities aimed at continued quality care.

  • Interprets and implements administrative policies and operational procedures.

  • Guides, mentors, motivates and engages the staff in assessing, planning, implementing programs and evaluating patient care as evidenced by patient satisfaction and positive clinical outcomes.

  • Screens and investigates incidents and patient complaints; determines follow-up needed and initiates corrective action.

  • Ensures compliance with all regulatory agency requirements.

  • Ensures availability of necessary tools and resources for the efficient management and coordination of patient care.

  • Provides for coordination of the patient's total care by ensuring appropriate and timely interventions for all services.
    2.Performs strategic planning and programmatic development for the Case Management Department.

  • Assesses staff's ability to manage and analyze the patient's total care needs, across the care-continuum and develops long and short-term goals to meet those needs.

  • Collaborates with physician leadership to develop strategies, formulate plans and implement interventions based on patient needs and clinical resources.

  • Collaborates with Patient Care Service Directors in evaluating patient care outcomes based on interventions.

  • Collaborates with Director of Social Work on the overall planning for social work services within the institution.

  • Collaborates with the Medical Nursing Leadership to evaluate outcomes, assess problem areas, analyze current trends and plan strategies to meet patient care needs and improve the deliver of care.
    3.Collaborates with Patient Financial Services, HIM and CDI leadership to maximize reimbursement.

  • Collaborates with Patient Access Services Leadership to ensure accurate data and coordination of patient flow.
    4.Manages department in a fiscally responsible manner.

  • Uses resources in an appropriate and cost efficient manner.

  • Develops the department budget.

  • Identifies, generates and implements cost containment intitiatives.
    5.Selects, develops, manages and evaluates direct reports; and oversees the selection, development, management and evaluation of indirect reports.
    6.Promotes staff development and education. Provides opportunity for formal and informal education to promote ongoing staff competency. Sets standards for performance and ensures timely completion of performance appraisals.
    7.Performs related duties, as required.


  • Bachelor's Degree in Nursing required. Master's Degree, preferred.

  • Current license to practice as a Registered Professional Nurse in New York State.

  • Certified Case Manager (CCM), Nurse Case Manager (RN, CM), Case Manager, Certified (CMC) or Certified Professional in Health Care Quality (CPHCQ), preferred.

  • Minimum of seven (7) years administrative case management experience in an acute care environment, including 3 years supervisory experience, required.

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Coordinates and facilitates the discharge planning process. * Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team. * Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services. * Ensures interdisciplinary care plan and discharge plan are consistent with the patient's clinical course, continuing care needs and covered services. * Conducts a case management assessment including the patient's physical, psychosocial and financial needs and issues. * Interviews patient or designated agent to assess discharge-planning needs. * Involves patient and/or family in discussion and planning for anticipated need for care following discharge. * Ensures discharge plan is safe and timely. * Completes paperwork and/or ensures paperwork is completed and distributed. * Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards. * Ensures continuing care services including transportation, durable medical equipment, etc. are appropriately arranged for and financially approved. 3. Performs concurrent utilization management. * Reviews appropriateness of patient's admission, need for continued stay and discharge criteria using established criteria. * Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan. * Ensures patient meets acute care criteria during each in-patient day. * Places patient on alternate level of care (ALC) status In concert with attending physician. * Responds to third party payer requests for concurrent clinical information providing all relevant documentation to ensure reimbursement within expected time frames. * Disseminates documents of non-coverage when appropriate. * Ensures compliance with current state, federal and third party payer regulations. * Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings. 4. 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Director, Case Management

Northern Westchester Hospital