Director Case Management Utilization Review

Director of Case Management

Upstate NY minutes from Syracuse and Rochester

Our client is a decorated 600+ bed system in a beautiful setting in Upstate New York.

They are a multi-institutional health system that provides a full range of acute and long term care health services to residents of the Finger Lakes region in Upstate New York. Acute and long term care services are provided on three campuses.

This award winning system seeks a progressive, experienced, innovative and service oriented individual to leads its Care Management department. The Director will be responsible for the overall leadership and management of Care Management for two acute care hospitals and the health system’s physician network. He/she will be responsible for leading efforts and activities to optimize care coordination across the health system. He/she will be expected to use his/her knowledge and skills to help resolve complex issues and serve as a resource for all team members. He/she will be responsible for achieving optimal patient outcomes in clinical care and cost effectiveness such as initiatives to manage length of stay and readmissions. The Director will work closely with all departments across the health system and with post-acute service providers to streamline and improve patient transitions through the health care system and into the community following discharge. This leader will also have a key role in DSRIP initiatives and the growth of swing bed services at one of the campuses.

Qualifications

Education:

• Master’s Degree in Social Work, Nursing or Business is required.

License/Certifications:

• Current NYS RN License or eligible or a MSW is required
• Nationally recognized Care Management certification is preferred

Experience:

The successful candidate for this position will possess:

• Five (5) or more years of care management experience including at least three (3) years of progressively responsible care management leadership experience for a hospital or health care system.
• Broad and extensive knowledge of care management, discharge planning, Joint Commission and Medicare, Medicaid and managed care standards.
• Experience developing utilization, clinical case management and concurrent review strategies, as well as, managing authorizations, denials and appeals processes.
• Experience analyzing and trending data, identifying opportunities for improvement and implementing solutions.
• Experience planning, organizing and leading projects.
• Experience applying best practices and innovative strategies to improve performance, optimize efficiency and achieve departmental and organizational goals.
• Experience establishing, building and developing positive relationships with management, staff and physicians. Must have a track record of success working collaboratively across an organization with interdisciplinary teams.

Our client offers an amazing and supportive work environment, aggressive salary, great benefits and opportunity to work with some of the best clinicians in the region!

For prompt and confidential consideration, please apply to the link below: