Director - Case Management
Myntegrity Solutions - Washington, DC

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Job Description

The Case Manager Director is responsible for Utilization Review, Discharge Planning, Care Coordination, and Social Service Functions. Clinical Documentation also reports to this position. POSITION SUMMARY: Directs, establishes and plans the overall policies and goals for the Case Management Department, including operational supervision of all utilization management and social work functions. Supports Utilization Management Committee in its activities and ensures staff is skilled in applying standard hospital guidelines utilized by payors (InterQual, Milliman). Duties include: planning and goal setting for department; clinical supervision and personnel management; implement quality improvement; interdisciplinary, community and provider relations; financial management, policy and procedure development and professional staff orientation and development. The director oversees the day-to-day clinical and financial operations of the Case Management department, leading the growth and development of programs and services that ensure the needs of patients are met across the continuum of care. Provides organization-wide leadership for Case Management operations including Case Management, Utilization Review, and Discharge Planning.


EDUCATION REQUIRED: RN; Master of Science in Nursing, or other healthcare related Master's degree preferred. SPECIALIZED TRAINING REQUIRED: Skilled in InterQual and/or Milliman criteria. Management of multidisciplinary department. LICENSE/CERTIFICATION/REGISTRATIONS REQUIRED: Licensed as a Registered Nurse in WA state. WA State Driver's License. EXPERIENCE REQUIRED: 5+ years recent clinical experience in a hospital setting and experience in management/leadership position within a healthcare organization. 3+ years experience in care management, discharge planning and /or utilization review experience. Master of Science in Nursing, or other healthcare related Master's degree preferred. KNOWLEDGE/SKILLS/ABILITIES Knowledge of utilization management activities including application of criteria (InterQual/Milliman). Knowledgeable about community, state and federal financial, health and social policy, regulations andprograms. Demonstrated skills in collaboration, teamwork and problem-solving to achieve goals. Case Management Certification CCM preferred. Master's degree preferred.

Additional Information

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Interviews are being scheduled NOW!

SALARY: DOE . Salary/Pay is based on experience; very negotiable and offering excellent salary.