Role Overview: Responsible for the day-to-day oversight and coordination of case management and discharge planning functions to ensure quality and efficient patient care while complying with regulatory standards.
Key Responsibilities: Collaborate with multidisciplinary teams to optimize patient flow, interpret payer guidelines, and ensure adherence to State and Federal discharge planning regulations. Utilize hospital information systems and clinical decision-making tools such as Interqual or Milliman guidelines. Lead process improvements, monitor performance, and support staff development. Make critical decisions in a high-pressure environment with minimal supervision.
Qualifications & Skills: Minimum three years of case management experience and two years of leadership in case management. Requires a nursing degree (RN or BSN) with preferred certification in Case Management. Strong critical thinking, communication skills, and knowledge of clinical criteria and regulatory requirements are essential.