Case Management Director - Ottumwa, IA

Position Overview:

The Director of Case Management plays a pivotal role in ensuring the delivery of high-quality, patient-centered care by leading and overseeing the hospital's case management program. This includes managing and optimizing care facilitation, utilization management, case management, and discharge planning processes. The Director will provide leadership, guidance, and supervision to Case Managers and Social Workers, ensuring compliance with all relevant regulations and standards while fostering a collaborative environment for multidisciplinary care.

Key Responsibilities:

Leadership & Supervision:

• Lead, mentor, and supervise the daily activities of the Case Management and Social Work teams, ensuring high standards of care and efficiency in patient management.
  
• Oversee the hiring, performance evaluations, scheduling, and payroll management for department staff, utilizing systems such as KRONOS.
  
• Facilitate daily multidisciplinary rounds, promoting collaboration among healthcare professionals to deliver comprehensive, holistic care to patients.
  
• Provide ongoing education and development opportunities for Case Managers and Social Workers to ensure continuous professional growth and departmental effectiveness.
  

Case Management & Compliance:

• Implement and manage the hospital's case management program, ensuring compliance with regulatory requirements and internal policies.
  
• Monitor and audit the department's documentation and practices to maintain alignment with Joint Commission, CMS, state, and local regulations.
  
• Participate actively in the Utilization Review Committee and Revenue Cycle Committee, contributing to the development of quality improvement programs and trending data analysis, such as Avoidable Days and Readmissions.
  

Patient Care & Discharge Planning:

• Collaborate with physicians to develop and implement appropriate plans of care, assist with level of care determinations, and manage bed placement assignments.
  
• Lead the discharge planning process, ensuring patients and their families receive the necessary education and resources for a smooth transition from hospital to home or other care settings.
  
• Maintain skills in case management and utilization review to cover patient caseloads as needed, ensuring continuous patient care across all areas of the hospital.
  

Resource Management & Utilization:

• Promote the efficient use of clinical resources by ensuring that the appropriate amount of resources is allocated based on patient acuity.
  
• Work closely with the Quality Department and Chief Financial Officer to develop, implement, and maintain programs aimed at improving patient outcomes and reducing costs.
  

Regulatory Compliance & Standards:

• Ensure that the department adheres to all applicable Joint Commission, CMS, and state regulations, as well as internal policies and professional standards.
  
• Develop and update departmental policies, procedures, and standards to align with payer requirements and discharge planning regulations.
  

Knowledge, Skills, and Abilities:

• Strong understanding of Medicare, managed care, inpatient, outpatient, and home health care, as well as utilization management, discharge planning, and case management.
  
• Ability to work collaboratively with healthcare professionals across all levels to achieve established goals and improve quality outcomes.
  
• Proficient in performance improvement concepts and strategies.
  
• Excellent communication skills, both verbal and written, with a demonstrated ability to build effective working relationships with physicians and other healthcare professionals.
  
• Self-motivated, assertive, and capable of working independently and as part of a team.
  

Requirements

Qualifications:

Education:

• Graduate of an accredited program of Registered Nursing.
  
• Bachelor of Science in Nursing (BSN) degree preferred.
  

Experience:

• Minimum of two years of experience in case management, utilization management, discharge planning, or related fields.
  
• Two to three years of prior management experience in a hospital-based nursing setting preferred.
  

Licenses/Certifications:

• Current RN license in the state of Iowa or a multistate license allowing practice in Iowa.
  
• Iowa Mandatory Reporter – Child and Dependent Adult Abuse Certificates.