RN Case Management Director

Job Summary: 

The RN Case Management Director is responsible for overseeing the monitoring and compilation of information concerning the necessity of patient admissions to the hospital and continued stay. This role involves reviewing patient records with an assurance mindset, ensuring compliance with federal and state quality and utilization requirements for patient care. This role also requires the coordination of patient care to assure exceptional quality in an economically responsible format.

Key Responsibilities:

1. Overseeing and coordinating quality management and case management activities for patient care.
2. Reviewing patient records and determining the necessity of admissions and extended hospital stays.
3. Ensuring compliance with federal and state requirements related to patient care and resource utilization.
4. Leading the coordination of patient care across the continuum to assure optimal quality.
5. Directing a team that includes Case Managers, Administrators, and Social Workers along with Utilization Review personnel.
6. Facilitating continuous communication with physicians and hospital staff.
7. Providing nursing leadership which includes accountability for all national coding structure guidelines and the Medicare reimbursement system.

Qualifications and Skills:

• Familiarity with NCT criteria is a plus.
• A Bachelor's degree in Nursing is preferred, but an Associate Degree in Nursing coupled with four years of experience can be substituted.
• Must have a minimum of 2 to 4 years experience in a hospital setting, depending on the level of education.
• Experience in Quality Management or Case Management activities is preferred.
• Proficiency in data analysis is desired.
• Excellent knowledge of medical terminology, age-specific needs, disease processes, and corresponding procedures.
• Strong clinical knowledge is required with an understanding of pathology/physiology of disease processes.
• Strong written and verbal communication skills.
• Excellent critical thinking and interpersonal skills.
• Capability to work independently in a time-sensitive environment.
• Computer literacy, including operational skills with basic office equipment.
• Assertive personality traits to enhance continuous communication with physicians.
• Valid RN license in the State of Texas.

The RN Case Management Director reports to the Chief Financial Officer (CFO) and has several job titles reporting to this role including Case Manager, Utilization Review staff, Administrative Assistant, and Social Services personnel.

The RN Case Management Director plays a significant leadership role, not only assuring the quality and economically sound nature of patient care but also driving compliance with all relevant regulations. The successful candidate must demonstrate a strong skill set that includes critical thinking, communication, leadership, and a deep understanding of healthcare procedures and policies.