Care Management Director

A growing healthcare facility located in Queens is seeking a self-motivated and experienced Registered Nurse (RN) for a promising opportunity on their staff as their new Care Management Director. In this role, the Care Management Director will direct and manage departmental activities involved in utilization review, appeals management and discharge planning to facilitate the case management process and maximize reimbursement to the facility. Apply today!

Healthcare Facility

The Care Management Director:

• Reviews department clinical services and operations
• Oversees activities of onsite Care Managers
• Develops relationships and seeks feedback from internal and external stakeholders regarding the implementation of department activities to garner satisfactory customer results
• Emphasizes a collaborative approach and seeks to influence other services by focusing on patient processes
• Develops and implements Utilization Review (UR) based on internal data collection, data received from external agencies, Physician Advisors and the Medical Director
• Ensures Discharge Appeals functions are carried out within contractual, federal and state guidelines
• Presents and reviews data relative to avoidable days, denials, length of stay and other key metrics to leadership
• Maintains necessary levels of staff qualifications, competencies, staffing levels (hiring and discharge), regulatory compliance, individual development plans, continuing education and performance appraisal
• Works collaboratively with Admitting, Transfer Services and Finance to ensure appropriateness of admissions and proper reimbursement

• BSN
• Active New York State Registered Nurse license
• 5+ years of experience as a manager or director
• Experience in hospital UR / Care Management
• Strong clinical background in nursing