Group Director of Case Management

Job Title: Director of Case ManagementLocation: Detroit, MISummaryVirtus Healthcare Staffing is partnering with a Level I trauma hospital in Detroit, MI, to identify a highly skilled and experienced Director of Case Management. This leadership position plays a critical role in overseeing the hospital's case management department, ensuring optimal patient care and resource utilization.ResponsibilitiesStaffing and Leadership:Maintain adequate staffing levels and skill mix to meet patient needs and departmental goals.Utilize industry-standard case management staffing recommendations and hospital budgetary guidelines for staffing requests.Conduct regular departmental meetings, provide updates, and offer ongoing education to staff.Complete initial and annual competency and evaluation reviews for all case management staff.Implement action plans for improvement based on InterQual Inter-rater Reliability (IRR) results.Utilization ManagementImplement and monitor processes to ensure medical necessity reviews and appropriate patient status and level of care.Oversee timely referral and documentation of cases for Physician Advisor review.Implement and monitor utilization review processes to support admission, level of care, length of stay, and authorization for post-acute services.Advocate for patient and hospital interests with payers to secure appropriate reimbursement.Care CoordinationCollaborate with hospital leadership to ensure effective Patient Care Conferences and Complex Case Review processes.Participate in daily bed management meetings to optimize patient placement and transfers.Monitor patient care plans for clinical appropriateness, alignment with patient choice, and availability of resources.Ensure effective communication and collaboration among the healthcare team to achieve patient care goals.Provide education to physicians and staff regarding medical necessity, documentation, and compliance.Regulatory ComplianceEnsure compliance with federal, state, and local regulations and accreditation requirements related to case management.Ensure departmental structure, staffing, policies, and procedures align with CMS Conditions of Participation and industry best practices.QualificationsEducation:Graduate of an accredited school of Nursing.Bachelor's degree in Nursing or a health-related field, or equivalent experience.Master's degree in Nursing, Business Administration, or Hospital Administration preferred.LicensureLicensed to practice as a Registered Nurse in the State of Michigan.ExperienceThree to five years of acute hospital case management leadership experience.Five years of acute hospital case management experience is preferred.McKesson InterQual® Experience Preferred.Business planning experience preferred.CertificationsAccredited Case Manager (ACM) preferred.SkillsStrong analytical, fiscal, communication, interpersonal, teaching, and project management skills.Demonstrated leadership ability and comfort with decision-making responsibilities.Technical knowledge of community resources, regulatory requirements, reimbursements, and utilization management procedures.