Job Description The Director of Case Management is responsible for the overall operation of the Case Management Department. This includes oversight of daily activities plus the forward planning of successful strategies to assure timely and efficient care to patients. This involves the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Director works with senior leadership to achieve performance targets and desired results by managing people, relationships, and processes conducted by professional staff in multiple disciplines. This individual ensures that the departments achieve their goals and objectives, and is expected to engage internal and external stakeholders in the improvement of clinical case management, outcomes management processes and throughput. Responsibilities 1.Reviews department clinical services and operations, and tracks case management activity. Identifies areas for performance improvement by examining productivity and workload within each department. Directs, coaches, mentors and assesses staff in clinical case management service delivery. 2.Maintains necessary levels of staff qualifications, competencies, staffing levels (hiring and discharge), regulatory compliance, individual development plans, continuing education and performance appraisal. 3.Manages resource use (staff/supplies) and directs expense and revenue decisions. Monitors outcomes management and staffing needs to adequately allocate personnel resources. 4.Ensures departments achieve institutional visions, goals and objectives by developing scope of service, establishing/maintaining effective relationships with physicians, and collaborating with other disciplines. Assesses goals and utilizes data to effect corrective action. 5.Oversees activities of onsite Case Managers. Presents regular productivity reports, and meets with Case Management staff on an individual basis to discuss targets and other issues of concern. 6.Manages relationships with payers and network providers by supervising the activities of the Resource Center. Works collaboratively with third-party payers and MSH managed care contracting to ensure compliance with contractual/regulatory guidelines. 7.Attends Joint Conference meetings with major payers. 8.Develops relationships and seeks feedback from internal and external stakeholders regarding the implementation of department activities to garner satisfactory customer results. 9.Emphasizes a collaborative approach and seeks to influence other services by focusing on patient processes. 10.Develops and implements Utilization Review (UR) based on internal data collection, data received from external agencies, Physician Advisors and the Medical Director. 11.Works collaboratively with Admitting, Transfer Services and Finance to ensure appropriateness of admissions and proper reimbursement. 12.Ensures Discharge Appeals functions are carried out within contractual, federal and state guidelines. Shares denial data with physicians and collaborates on strategies to reduce denials. Works collaboratively with the Medical Centers Appeals Management Program. 13.Presents and reviews data relative to avoidable days, denials, length of stay and other key metrics to leadership. 14.Other duties as assigned. Qualifications
- BSN in Nursing or health related field, Masters preferred
- 5 years case management and 6 years as clinical nurse. Previous supervisory experience in case management or related field.
- Name: Current Nursing licensure Issuing Agency: New York State
- Certification in case management is preferred
Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West About Us
Strength Through Diversity The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai's unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:
- Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential.
- Serving as a role model confronting racist, sexist, or other inappropriate actions by speaking up, challenging exclusionary organizational practices, and standing side-by-side in support of colleagues who experience discrimination.
- Inspiring and fostering an environment of anti-racist behaviors among and between departments and co-workers.
At Mount Sinai, our leaders strive to learn, empower others, and embrace change to further advance equity and improve the well-being of staff, patients, and the organization. We expect our leaders to embrace anti-racism, create a collaborative and respectful environment, and constructively disrupt the status quo to improve the system and enhance care for our patients. We work hard to create an inclusive, welcoming and nurturing work environment where all feel they are valued, belong and are able to advance professionally. Explore more about this opportunity and how you can help us write a new chapter in our history!
About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time - discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients' medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high Honor Roll status, and are highly ranked: No. 1 in Geriatrics and top 20 in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report's Best Children's Hospitals ranks Mount Sinai Kravis Children's Hospital among the country's best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek's The World's Best Smart Hospitals ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. The Mount Sinai Health System is an equal opportunity employer. We comply with applicable Federal civil rights laws and does not discriminate, exclude, or treat people differently on the basis of race, color, national origin, age, religion, disability, sex, sexual orientation, gender identity, or gender expression. We are passionately committed to addressing racism and its effects on our faculty, staff, students, trainees, patients, visitors, and the communities we serve. Our goal is for Mount Sinai to become an anti-racist health care and learning institution that intentionally addresses structural racism.
EOE Minorities/Women/Disabled/Veterans