Director of Case Management

Overview

Position: Director of Case Management

Starting Salary: $89,440.00 to $114,108.00 Annually 

Location: St. Mary's General Hospital – Passaic, New JerseyEmployment Type: Full-Time | Exempt

St. Mary's General Hospital is seeking an experienced Case Management Director  who will be responsible for the development of staff and systems to effectively operate a comprehensive Case Management Program. Provides leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians.  Assesses needs and plans, communicates and designs services that are appropriate to the hospital mission and patient/family needs.  Integrates and coordinates services using continuous quality improvement tools.

Responsibilities

• Assists in clinical reviews utilizing criteria approved by the Utilization Review Committee. Determines priorities in which patients need to be reviewed.
• Applies appropriate clinical judgment in the review process to ensure that information in the medical records meet the criteria for intensity of care level of service for continued hospital stay and/or discharge.
• Documents all deviations from criteria for continued length of stay and promptly discusses these with the attending physician and/or Medical Director.
• Communicates daily, or as needed, with the Medical Director, or his designee, regarding difficulties with resource utilization.
• Participates actively in discharge planning and coordinating appropriate discharge plans based upon the identified needs of the patient and the availability of resources.
• Communicates, as requested by insurance carrier, needed information regarding intensity of care and level of service. Abides with HIPAA regulations.
• Performs retro reviews, on patients who have been discharged when applicable.
• Assists in appeal process on any insurance denial when requested.
• Provides leadership role in maintaining proactive goals and objectives of the Case Management Department in reducing medically aberrant LOS, and establishes personal goals to achieve desirable outcomes organizationally.
• Collaborates in a leadership role with interdisciplinary team and community to uphold readmission reduction team goals.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

Required qualifications:

1.    Licensed clinician in your state or;

2.    Grandfathered prior to April 1, 2015. Minimum 5 years’ post graduate of an accredited school of Social Work for Licensed           Clinical Social Worker.

3.    Minimum 5 years’ experience in a Case Management position.

4.    Must have analytical ability for problem identification and assessment and evaluation of data/statistics obtained from an            on-going review process.

5.    Experience and knowledge in basic to intermediate computer skills.

Preferred qualifications:

1.    CCM or obtained within 1year2.    BS or BSN or related field preferred.3.    Current BCLS certificate preferred.4.    Knowledge of Milliman Criteria and InterQual Criteria preferred.

St. Mary's General Hospital, located in Passaic, NJ, is a community-based tertiary medical center focused on providing quality, compassionate care. It is an acute care hospital providing a broad range of services including cardiovascular services as well as a comprehensive program for cancer care. The hospital is also a center of excellence for maternal-child health and outpatient behavioral health services.  It is the only hospital in Passaic and with over 550 physicians and 1,000 employees, and is one of the largest employers in the county. Every member of the St. Mary's General team is committed to providing respectful, personalized, high-quality care. St. Mary's General Hospital is a member of Prime Healthcare, which has been lauded as a "Top 15 Healthcare System" by Truven Health Analytics. For information, visit www.smh-nj.com.

Pay Transparency

St. Mary's General Hospital offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $89,440.00 to $114,108.00 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf