The Senior Director of Case Management is responsible and accountable for the system-wide
operation of Case Management. This includes establishing and updating systemwide policies and
procedures, coordinates training, develops KPI's . The Senior Director of Case Management works
closely with the Managed care department to ensure contracting issues related to care and clinical
denials are addressed and ensuring all contracted requirements are in place. Promotes a collaborative
process with all service providers that assesses plans, implements, coordinates, monitors and
evaluates the options and services required to meet the patients' health and human service needs.
This is characterized by advocacy, communication, resource management, and the promotion of
quality and cost effective interventions and outcomes.
Bachelor's degree in Nursing Education, Health Administration, or Business Administration
required. Masters degree preferred.
10+ years of experience in Hospital Case Management with minimum of five years management
experience showing progressive responsibility.
Registered Nurse; RN required. InterQual certification required.
Knowledge of business and management principles involved in strategic planning, resource
allocation, human resources modeling, leadership technique, production methods, healthcare
reimbursement, utilization management, discharge planning, community resources and coordination
of people and resources. Skill in monitoring/assessing the performance to make improvements or
take corrective action. Skill in using logic and reasoning to identify the strengths and weaknesses of
alternative solutions, conclusions, or approaches to problems. Ability to plan, implement, and
evaluate programs. Ability to establish goals and objectives. Ability to recognize, analyze, and solve
a variety of problems. Excellent written and verbal communication skills. Strong interpersonal skills;
ability to collaborate well with others. Proven track record of building relationships. Ability to work
in a high volume environment and provide effective and efficient clinical and customer services to
members and providers.