Rn Director of Care Management

    February 20, 2023
    NY, New York
    Job Type
    New York


    RN Director of Care Management

    In the heart of New York’s scenic Finger Lakes region on the northern rim of Seneca Lake rests the historic, charming, and picturesque small city.  A visit to here should include sampling award-winning wines, learning about the area’s amazing history, basking in the romance of an 18th-century castle, and enjoying the eclectic food scene.


    Salary Range: $115,000-$135,000

    Relocation Assistance

    132 licensed beds, acute care facility



    • Supervises professional and clerical employees who work with a range of functions, including but not limited to access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, care coordination collaborative treatment planning and core measures, discharge planning, clinical social work, tracking of the post-acute period and provision of disease management, and contracting internally and externally.
    • Partners with the CMO for effective relationships with physicians, services, specialties, etc.
    • Provides consultation to the executive team, forming effective relationships with all VPs and department leaders.
    • Participates in the determination and definition of the Care Management Dashboard, using data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies.
    • Establishes, implements, and evaluates a written strategic plan for the department that considers internal and external factors.
    • Establishes, manages, and constantly evaluates staffing levels, assignments, skills, learning needs, and deployment of staff.
    • Creates stable and reliable processes to anticipate and address specific situations within the department and between the department and other departments and agencies.
    • Establishes effective communication systems and forums with third party payers, the local PRO/QIO, Medical Records, and the managed care and finance offices.
    • Develops structures and processes to facilitate participation by physicians, physical therapists, social work, and other health professionals in multidisciplinary care planning, care delivery, and discharge planning.
    • Participates in continuous quality improvement groups.
    • Negotiates, approves, and manages the operational and capital budgets.
    • Writes and conducts annual and interim performance appraisals for all staff in the department.
    • Reports to CMO
    • 7 FTE’s





    • Master’s in social work, Business or Nursing required.




    • Current NYS RN license




    • Five-year experience in a healthcare setting.
    • Three-year experience in utilization management or denial management.
    • Knowledge and experience in developing utilization management and revenue recovery strategies.
    • Experience dealing with authorizations and appeals process.
    • Knowledge of discharge planning and clinical case management strategies.
    • Knowledge and experience in project management and team dynamics.
    • Knowledge of and experience with basic research methods and statistical analysis.


    • DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, HIPAA



    • Ability to facilitate project management, work effectively under pressure, meet deadlines, manage multiple priorities, and enhance the spirit of teamwork through effective role modeling.
    • Familiarity with JCAHO requirements.
    • Excellent leadership, interpersonal, communication (written and oral), analytical, and organizational skills.
    • Demonstrated ability to deal effectively with the public in a professional and courteous manner.
    • Computer literacy required with word processing, spreadsheets, power point.


    • Experience with Microsoft Office products including word, excel and power point.










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