• Regularly directs the work of the Case Management department. Has the authority to hire, fire and counsel staff.
• Directs Case Management activities to control cost of high risk and high-cost populations.
• Interfaces with Physicians, nurses, social workers, Medical Records, Administration, outside agencies and other hospital departments to affect changes in the management of cases for the improvement in quality of care and/or the efficiency with which the hospital resources are utilized.
• Develops, implements and manages budget, customer service and financial indicators set for Case Management department.
• Oversees Discharge Planning, Utilization Review, Case Management, Social Services, Transitional Care processes and personnel.
• Provides concurrent and retrospective reviews to insurance companies for authorization of services.
• Presents reports and statistics to the Utilization Review/Health Information Management Committee.
• Responsible for Quality Improvement, Budgets, Policies/Procedures and daily intervention.
• To facilitate appropriate utilization of hospital and community resources to provide cost-efficient care, provision of services and meet the requirements of regulatory and accrediting agencies.
• Updates and expands the UM/Case Management programs as necessary.
• Provides budgetary management and supervisory responsibilities of the Case Management Department.
• Designs and maintains a Case Management reporting process, utilizing available computer/IS programs.
• Analyzes and reports Utilization Management Committee activities to the Quality Council, Administration, medical staff and other involved entities.
• Responsible for orienting, training, establishing work standards, conducting performance evaluations, hiring/disciplinary actions for the Case Management staff.
• Designs, implements, and oversees the Case Management Department.
• Coordinates the development and integration of Disease State Management programs in conjunction with the medical staff, nursing and ancillary departments.
• Responsible for assuring that Case management Staff who provide direct services are consistently maintaining a high level of ability and skills in developing Case Management Plans and are provided with updated clinical, medical necessity criteria and community resource information.
• Assures hospital compliance in regard to the requirements of regulatory agencies related to Utilization Review, Discharge Planning and Case Management functions.
• Proactively assists physicians in the management of their patient by facilitating care delivery through effective interactions with hospital wide departments.
• Works with Transitional Care Manager to reduce unnecessary Inpatient readmissions.

Education: Bachelor of Science in Nursing (BSN) preferred. A Master of Social Work (MSW) will be considered with substantial direct experience in clinical case management

Experience: Five years clinical experience, to include a combination of 3 years Utilization Management and Managed Care experience, including Case Management

Licensure: Current, valid Arizona RN license or compact sate RN license, if RN

Knowledge, Skills, and Abilities:

• Demonstrates effective interpersonal, organizational, and motivational skills and proficiency in written and verbal communication
• Basic computer skills
• Ability to work under pressure of timeframes when responding to verbal and written requests
• A certain degree of creativity and latitude is required
• Requires experience in evaluation techniques, teaching, hospital operations and medical staff relations with a minimum of five years managerial experience

• Able to handle multiple priorities simultaneously.
• Demonstrates good oral and written communication skills.
• Able to manage technical business equipment i.e. phone, fax, computer etc.
• Able to assist with the movement of an adult patient weighing up to 300 lbs.
• Able to care for patients with infectious diseases.
• Able to sit, stand, bend, and walk for duration of the shift.