Director Case Management-Mount Sinai West and Morningside- Full Time-Days

The Director of Case Management is responsible for the overall operation of the Case Management Department. This includes oversight of daily activities plus the forward planning of successful strategies to assure timely and efficient care to patients. This involves the delivery of comprehensive front-line Case Management services, including utilization management, care facilitation and discharge planning. The Director works with senior leadership to achieve performance targets and desired results by managing people, relationships, and processes conducted by professional staff in multiple disciplines. This individual ensures that the departments achieve their goals and objectives, and is expected to engage internal and external stakeholders in the improvement of clinical case management, outcomes management processes and throughput.

1.Reviews department clinical services and operations, and tracks case management activity. Identifies areas for performance improvement by examining productivity and workload within each department. Directs, coaches, mentors and assesses staff in clinical case management service delivery.

2.Maintains necessary levels of staff qualifications, competencies, staffing levels (hiring and discharge), regulatory compliance, individual development plans, continuing education and performance appraisal.

3.Manages resource use (staff/supplies) and directs expense and revenue decisions. Monitors outcomes management and staffing needs to adequately allocate personnel resources.

4.Ensures departments achieve institutional visions, goals and objectives by developing scope of service, establishing/maintaining effective relationships with physicians, and collaborating with other disciplines. Assesses goals and utilizes data to effect corrective action.

5.Oversees activities of onsite Case Managers. Presents regular productivity reports, and meets with Case Management staff on an individual basis to discuss targets and other issues of concern.

6.Manages relationships with payers and network providers by supervising the activities of the Resource Center. Works collaboratively with third-party payers and MSH managed care contracting to ensure compliance with contractual/regulatory guidelines.

7.Attends Joint Conference meetings with major payers.

8.Develops relationships and seeks feedback from internal and external stakeholders regarding the implementation of department activities to garner satisfactory customer results.

9.Emphasizes a collaborative approach and seeks to influence other services by focusing on patient processes.

10.Develops and implements Utilization Review (UR) based on internal data collection, data received from external agencies, Physician Advisors and the Medical Director.

11.Works collaboratively with Admitting, Transfer Services and Finance to ensure appropriateness of admissions and proper reimbursement.

12.Ensures Discharge Appeals functions are carried out within contractual, federal and state guidelines. Shares denial data with physicians and collaborates on strategies to reduce denials. Works collaboratively with the Medical Centers Appeals Management Program.

13.Presents and reviews data relative to avoidable days, denials, length of stay and other key metrics to leadership.

14.Other duties as assigned.

• BSN in Nursing or health related field, Masters preferred
• 5 years case management and 6 years as clinical nurse. Previous supervisory experience in case management or related field.
• Name: Current Nursing licensure Issuing Agency: New York State
• Certification in case management is preferred

Compensation Statement

The Mount Sinai Health System (MSHS) provides a salary range to comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for this role is $115,494.00 - $173,241.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and hospital need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

Non-Bargaining Unit, BEZ - Utilization Management - WST, Mount Sinai West

Strength Through Diversity

The Mount Sinai Health System believes that diversity, equity, and inclusion are key drivers for excellence. We share a common devotion to delivering exceptional patient care. When you join us, you become a part of Mount Sinai’s unrivaled record of achievement, education, and advancement as we revolutionize medicine together. We invite you to participate actively as a part of the Mount Sinai Health System team by:  

• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and re