The Director of Case Management promotes professional accountability for the mission and strategic goals of the organization through essential duties and responsibilities. Under direction of senior leadership, the Director leads case management staff, Social Workers, and support personnel whose chief responsibilities include (but are not limited to) adherence of regulatory requirements (such as the Centers for Medicare and Medicaid Services’ Conditions of Participation); care coordination and facilitation; discharge planning; medical necessity/clinical reviews; psycho-social support for high risk and complete care patients; and utilization of resources.
Required Skills
- Working knowledge of insurance and third party payer processes required.
- Knowledge of Centers for Medicare and Medicaid Services’ Conditions of Participation required.
- Knowledge of personnel, administrative and financial procedures and practices, as well as principles, techniques, terminology and procedures of sound management is required.
- Experience with program implementation and computer business applications required.
- Knowledge/Application of the InterQual application tool for Medical Necessity required.
Required Experience
Work Experience
- Three-five (3-5) years management experience required.
- 1-3 years recent experience in a pediatric hospital setting preferred.
License/Registration/Certification
- Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners required.
- Case Management certification (ACM, CCM or ANCC) preferred.
- American Heart Association, Basic Cardiac Life Support.
- Pediatric Advanced Life Support within 6 months of hire.
Education and Training
- BSN required.
- Masters degree in Nursing, Business Administration or Healthcare Administration preferred.