Dir - Case Mgmt - CHMC Utilization
Company: The Clinical Recruiter
Posted on: January 11, 2022
(Only QUALIFIED Healthcare Professionals accepted) Case
Manager-RN - Dir - Case Mgmt - CHMC Utilization Management
The Director of Case Management leads and manages the day-to-day
operations of utilization, clinical resource and case management
departments and focuses on the continuum of care for the patient
Develops case management programs that allows the hospital(s) to
meet clinical resource management goals as well as third party and
Manges and educates staff at all levels about effective clinical
resource management. Provides formal and informal programs.
Maintains effective working relationships and effectively
communicates the goals and objectives of the program to the medical
staff, department staff, and others within and outside the
Evaluates the effectiveness of existing clinical protocols and
pathways and makes recommendations for new ones.
Promotes organizational mission statement and goals and empowers
staff and peers to achieve outstanding performance.
Effectively reports departmental activities, goals, and measures of
Works effectively with MCO staff and leadership to decrease denials
or downgrades in reimbursement.
Maintains department standards for regulatory and accreditation
Actively seeks to resolve those issues brought forward by medical
staff that have an adverse effect on patient outcomes.
Analyzes the issues for cost-benefit in terms of improving clinical
and financial outcomes.
Prioritizes and recommends effective approaches that will improve
clinical and financial outcomes in the hospital.
Primary liaison between Case Management and the hospital Quality
Recommends plans of care for high profile DRGs that incorporate
effective Case Management strategies.
At least 3+ years Nursing Management experience in an acute care
Hospital Case Management experience required
Managed Care Organization (MCO) experience preferred
Licensed clinician in your state.
Minimum 5 years experience in a Case Management position
Behavioral Violence Prevention Training within 3 months of hire and
Bachelor of Science in Nursing (BSN) required, Certification in
Masters Degree in Nursing or a related healthcare field
Registered Nurse License required
Certified Case Manager (CCM) a plus, not required
Healthcare Quality of Utilization Review (HQUR) a plus, not
Current BCLS (AHA) certificate preferred
Knowledge of Milliman Criteria and InterQual Criteria preferred
Advanced communication and interpersonal skills
Analytical and quantitative analysis skills
Ability to lead a complex department to reach and exceed goals
Ability to work with other departments
Knowledge of Managed care trends, Medicare and Medicaid
Keywords: The Clinical Recruiter, Inglewood , Dir - Case Mgmt - CHMC Utilization, Other , Inglewood, California
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