Registered Nurse/Director of Case Management

Summary:

BHDDH is expanding their Case Management Program at Eleanor Slater Hospital. The Director of Hospital Case Management will provide strategic leadership and operational

oversight for all case management and utilization review functions within a state-operated long-term acute care hospital. This role ensures the delivery of appropriate, cost-effective, high-quality care while maintaining compliance with regulatory and payer requirements across the continuum of care.

Key Responsibilities

• Participate in daily interdisciplinary care rounds, collaborating with physicians, nursing, social work, and ancillary services to evaluate, develop, and implement case management plans
• Serve as a liaison with the Patient Resources and Benefits Division
• Identify high-risk patients and coordinate targeted interventions with the healthcare team
• Gather and analyze clinical information using established criteria, guidelines, policies, and clinical judgment to support coverage determinations
• Provide coordinated care support to facilitate and expedite patient services
• Communicate post-hospital recommendations and collaborate with Social Work to support timely and safe discharge planning
• Develop and maintain patient care reports to ensure effective handoffs during transitions of care
• Coordinate length-of-stay management with providers, patients, and families, including education on insurance qualifiers impacting discharge
• Advocate for patients regarding financial implications related to discharge planning
• Oversee insurance pre-authorizations for inpatient services, continued stays, post- acute placement, and ancillary services
• Ensure timely submission of clinical documentation and compliance with payer- specific requirements
• Collaborate with payers and internal stakeholders to resolve authorization denials and conduct peer-to-peer reviews as needed
• Identify opportunities to improve patient flow and reduce delays in care delivery
• Participate in departmental and interdepartmental quality improvement initiatives
• Ensure operations align with organizational standards and regulatory requirements
• Maintain compliance with federal, state, and local case management regulations

Required and Preferred Skills

• BSN from an accredited nursing program
• Current RN license to practice in the State of Rhode Island
• Certification by a recognized national organization in case management is preferred
• 3 years of clinical case management experience preferred
• Utilization management experience, including demonstrated experience obtaining insurance pre-authorizations and managing payer authorization processes across the continuum of care

Work Location:

This position will work onsite at both Eleanor Slater Hospital locations, including the Cranston Campus (Cranston, RI) and the Zambarano Unit (Pascoag, RI).