Director of Care Management
Trinity Health
full-time
Posted on:
Location Type: Office
Location: Langhorne • Pennsylvania • United States
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Job Level
About the role
- Directs the overall care management program, including case management, social work, and utilization review.
- This involves setting departmental goals, establishing policies, and managing budgets.
- Maintains collaborative relationship with Medical Staff and facilitates education on documentation, government regulations and payer contracting matters.
- Oversees processes to ensure patients are at the correct level of care (e.g., observation vs. inpatient) and that hospital resources are used efficiently.
- Lead the Utilization Management Committee to report on denial trends and resource consumption.
- Assures hospital adherence to all Federal, State, and Local regulatory and compliance guidelines related to utilization.
- Oversight of critical processes related to compliance of both medical necessity and appropriate level of care; coordinates utilization review processes to assure adherence to regulations.
- Supports the Utilization Management and Appeals Supervisor and the Manager of Care Management to assure the functions of care coordination in the acute setting meet the goals of resource consumption, capacity management and patient centered care.
- Develops programs to support length of stay initiatives to manage capacity and assure the right care at the right time.
- Assures hospital adherence to all regulatory guidelines related to discharge planning.
- Continuously seeks best practice approaches to assuring patients are discharge ready including coordination of services, coaching, and transition of information.
Requirements
- Master of Science in Nursing (MSN) degree from an accredited school of nursing required.
- Current Registered Nurse license by Pennsylvania Board of Nursing or Compact State.
- At least 3-5 years' leadership experience in case management.
- CCM (Certified Case Manger) or ACM (Accredited Case Manager) preferred.
Benefits
- Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
- Work/Life balance with flexible schedules.
- Free onsite parking.
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementutilization reviewcare coordinationdischarge planningresource consumptioncapacity managementcompliancedocumentationgovernment regulationspayer contracting
Soft Skills
leadershipcollaborationeducationcoachingprogram developmentbest practice approachescommunicationorganizational skillsgoal settingpolicy establishment
Certifications
Master of Science in Nursing (MSN)Registered Nurse licenseCertified Case Manager (CCM)Accredited Case Manager (ACM)