Director of Case Management

The Director of Case Management is responsible for the oversight of the Case Management unit, including but not limited to clinical resource management, discharge planning activities, patient advocacy, clinical social work, and best practices in medical necessity determination and concurrent review. The Director is accountable for the execution, adaptation, and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care, and adherence to a designated Geometric Length of Stay (GLOS) for each patient.

**Essential Functions:**

The Director is responsible for the overall direction and management of these areas, including planning, organizing, and directing all activities, staffing, performance improvement in the delivery of clinical services (such as LOS reduction), and reporting needs within the RRHS, as well as government and regulatory reporting.

The Director guides Care Coordination activities according to the needs, requirements, and policies of RRHS, the affiliated medical groups and health plans, and any Federal and State agencies, as well as according to standard practices of the professions under the Director's accountability.

The Director will consult and collaborate with other managers, physicians, administration, and community-based healthcare workers regarding care management issues identified through corporate or facility initiatives and current literature.

This position will work closely with all departments at the medical center and the post-acute service providers to streamline the patient transition through the healthcare system and into the community post-discharge.

The Director participates regularly in RRHS, Service Area, or Corporate meetings pertinent to the accountable areas and also participates in corporate strategic planning and performance improvement teams and programs as necessary.

This position requires full understanding and active participation in fulfilling the Mission of the Organization. It is expected that the Director will demonstrate behavior consistent with the Core Values of the organization. The Director is expected to support the Organization's strategic plan and the goals and direction of the Performance Improvement Plan (PIP).

The Director assists with developing specific departmental goals, standards, and objectives that directly support the strategic plan and vision of the organization.

The Director assesses the quality of patient care delivered and coordinates patient care services with patients, staff, physicians, and other departments.

The Director creates and fosters an environment that encourages professional growth.

The Director integrates evidence-based practices into operations and clinical protocols.

The Director works with physicians, nurses, ancillary staff, and social services at the point of care to facilitate multi-disciplinary decision-making that is consistent with the goals and objectives of the plan of care and the wishes of both the patient and family.

The Director must understand payer issues regarding patient management and the resulting implications of clinical decisions and anticipate opportunities to reduce expenses and capture revenue appropriately from admission through discharge.

The Director educates physicians and staff in Case Management standards and assists them in meeting the regulations and standards as requested by Joint Commission, OSHA, CMS, HCFA, AHCA, and other regulatory agencies. The Director educates and mentors all staff in UR standards and LOS topics.

The Director ensures effective Utilization Review processes.

In addition, this position considers the population served by RRHS and area clinical integration programs and leads efforts to optimize care coordination across the care continuum. This coordination ensures a plan of care for patients in all states of health needs.

**Minimum Education:**

- Associate's Degree in Nursing required
- Bachelor's Degree in Nursing or Master's Degree in a related field preferred
- Current RN license to practice in NC (NC licensure or multi-state (compact) license)

**Required Skills:**

- Certifications:
- BLS required
- ACMA Certification Preferred
- CCM Certification completion within the first year of employment or transfer to the role

- Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

- Comprehensive knowledge of care management and discharge planning, Medicare and Medicaid admission and review requirements, and general commercial admission and review requirements.

- Working knowledge of Interqual criteria.

- Working knowledge of finance and budgetary processes, and government billing regulations.

- Effective communication skills, especially with medical staff.

- Knowledge of Conditions of Participation and Joint Commission standards.

- Excellent customer service and presentation skills are a must.

- Strong interpersonal and written communication skills are essential.

- Demonstrated ability to apply analytical and problem-solving skills.

- Demonstrated ability to manage multiple tasks or projects effectively.

- Ability to work independently as needed with a high degree of detail orientation.

- Capable of planning and organizing projects with short notice.

- Ability to work efficiently in a fast-paced environment.

**Minimum Work Experience:**

- Minimum 3 years RN experience (acute care) and/or Care Coordination experience required.
- Minimum 3 years management experience preferred.

**Company Culture & Perks:**

Rutherford Regional Health System is a 143-bed acute care facility that offers a broad array of inpatient and outpatient care. Rutherford Regional is dedicated to providing patients with a full range of services to meet their healthcare needs. We provide our services in a caring, professional environment through the teamwork of our medical staff and employees.

Rutherford Regional Health System’s partnership with Duke LifePoint Healthcare is bringing the pieces together to transform healthcare in Rutherford County. Duke LifePoint Healthcare is a joint venture of Duke University Health System, one of the country’s leading academic health systems, and LifePoint Health, a leading healthcare company dedicated to Making Communities Healthier. These two forces joined because of the shared interest in collaborating with hospitals, healthcare providers, and patients to bring high-quality, innovative healthcare services to communities. Duke LifePoint combines Duke’s unparalleled expertise in clinical excellence and quality care with LifePoint's extensive resources and knowledge and experience operating community hospitals and healthcare organizations.

**Benefits - Wide range of benefits options!**

Here at Rutherford Regional, you choose your own Medical, Dental, and Vision plans from a variety of competitive options that give you the coverage that best fits your needs.

- HSA
- 401(K) retirement plan contributions
- Generous Paid Time Off
- Accident & Critical Illness Insurance
- Prescription Assistance with OptumRx
- Income protection programs for the entire family such as life insurance, Short/Long-term Disability, and Identity Theft.
- Employee Assistance program at no cost to you to provide emotional, legal, financial, and daily life support for your entire household. Services are available 24 hours a day, 7 days a week.
- Free travel and entertainment discount program to ensure you enjoy your time away from work.

**Why join our team?**

We are dedicated to providing patients with a full range of services to meet their healthcare needs, and we believe our employees are our most valuable assets in accomplishing this goal. Rutherford Regional is growing its team of dedicated healthcare professionals. If you are looking to start a career that cares, are passionate about changing lives, and are ready to work in a supportive environment in a close-knit community, apply today!

Equal opportunity and affirmative action employers are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran.