Regional Director (RN) - Case Management Operations - Lancaster/Lebanon

Job Description:

RN          Under the general supervision of the Corporate Director-Case Management, Regional Director supervises and oversees the operations of the Case Management Department in the designated region of WellSpan Health. Works with hospital, regional, medical group, Population Health, post-acute services and system leadership to support the operational achievement of strategic goals. Helps to identify and works in a team leadership model to develop and maintain departmental operations that are consistent with Health System and Community requirements/needs. Provides leadership regarding future strategic goals and the integration of case management principles throughout the System.

**  Concentration on Lancaster/Lebanon inpatient Case Management Departments

Duties and Responsibilities

1. Executes and coordinates the Utilization Review and Case Management operations at System hospital sites in designated regions and coordinates with Regional leadership, Corporate Case Management Director, and peer Case Management leadership regarding payer contract performance and the function of precertification, concurrent review and denial management.
2. Oversees analysis of Utilization Review trends and works with hospital leadership to address and solve problems.
3. Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy; conducts chart reviews and analysis of UR and compliance reports.
4. Oversees the acute care function and policy development of case management including Utilization Review, Social Services and care coordination, compliance and regulatory standards.
5. Manages the Case Management operations staffing and budget in designated region for both inpatient and ambulatory case management functions and coordinates with peer Case Management leadership throughout the System.
6. Identifies care management programming needs which require case management across the continuum. Collaborates with regional leadership team members on the operations of these programs.
7. Works with leadership in the WellSpan hospital, Medical Group and Post-Acute services to coordinate case management activities across the continuum of care
8. Leads strategic goals/ priorities that supports business transformation, population health functions and care coordination in collaboration with the appropriate leadership members.

Qualifications

• Minimum Experience:
  • 2 - 3 years
• Minimum Education:
  • Master’s Degree
• Preferred Field Of Expertise:
  • Utilization management, case management, or clinical nursing specialty
• Required Certification:
  • Registration and current RN license in PA