Director of Care Management / RN Licensed

Location: Geneva, NY
Director of Care Management / Licensed RN:
  • Permanent Position.
  • Full-Time (Day Shift).
  • Competitive Compensation, based on qualifications.
  • $120,000 - $135,000 per year.

  • Up to $140,000 - $160,000 for extensive experience.

  • Relocation Assistance Provided.
  • Comprehensive Benefits Package.
  • Location: Geneva, NY (Finger Lakes Region).
  • (Ability to Travel a short distance from Geneva to Penn Yan).
  • Reports to: Chief Medical Officer
  • Department: Care Management
  • Education: REQUIRED - Master's degree in Social Work, Business, or Nursing.
  • License: Valid NYS RN license required
  • Experience: *Must have Current Hands-on Clinical experience; with Care Management Experience in an Acute Care Hospital Setting- Not limited to UR and Payor Side experience.
  • Experience: Case/Care Management Experience in Acute Care.
  • Minimum Requirement: Five years' experience in a healthcare setting. Three years' experience in utilization management or denial management. Knowledge and experience in developing strategies for utilization management and revenue recovery. Familiarity with authorizations and appeals process. Proficient in discharge planning and clinical case management strategies. Competence in project management and team dynamics. Knowledge and experience with basic research methods and statistical analysis. Preferred: Familiarity with DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, HIPAA.
  • Responsibilities: Must be actively involved, as this position requires a servant leader approach. Oversees professional and administrative staff members engaged in various functions, including but not limited to access, pre-authorization and precertification, bed placement, coding, utilization review and denial management, collaborative care coordination and treatment planning, core measures, discharge planning, clinical social work, post-acute period tracking, disease management, and internal and external contracting. 2. Collaborates with the CMO to establish and maintain positive relationships with physicians, services, specialties, etc. 3. Provides consultation to the executive team, fostering positive relationships with all VPs and department leaders. 4. Contributes to the development and definition of the Care Management Dashboard, utilizing data to identify department strengths and weaknesses and inform decision-making and strategy development. 5. Formulates, implements, and evaluates a written strategic plan for the department, taking into account both internal and external factors. 6. Manages and assesses staffing levels, assignments, skills, training needs, and staff deployment on an ongoing basis. 7. Establishes reliable and efficient processes to anticipate and address specific situations within the department and between departments and agencies. 8. Implements effective communication systems and platforms with third-party payers, the local PRO/QIO, Medical Records, and the managed care and finance offices. 9. Establishes structures and processes to facilitate involvement of physicians, physical therapists, social work, and other healthcare professionals in multidisciplinary care planning, care delivery, and discharge planning. 10. Participates in continuous quality improvement initiatives. 11. Negotiates, approves, and manages the operational and capital budgets. 12. Conducts annual and interim performance appraisals for all staff within the department.
  • Proficient in project management, able to work well under pressure, meet deadlines, prioritize multiple tasks, and promote team spirit through exemplary role modeling. Familiarity with JCAHO requirements. Strong leadership, interpersonal, communication (written and verbal), analytical, and organizational skills. Demonstrated ability to interact effectively with the public in a professional and courteous manner. Computer literacy required, including proficiency in word processing, spreadsheets, and power point presentations.
  • Geneva is a charming city in New York State, situated at the northern end of Seneca Lake, which is part of the Finger Lakes Region. The area offers scenic wine trails, a rich historical background, breathtaking natural beauty, and year-round attractions.
    In neighboring Cayuga Lake, you will find the city of Ithaca, home to Cornell University. The surrounding region is characterized by its impressive gorges, many of which feature stunning waterfalls, such as Taughannock Falls and Buttermilk Falls.
    Watkins Glen State Park, located near the tip of Seneca Lake, is recognized for its rocky cliffs and cascading waterfalls, as well as its trout fishing opportunities. Southwest of Geneva, you can explore the Corning Museum of Glass. To the north, the Old Erie Canal provides hiking, canoeing, and fishing opportunities. Rochester, a city overlooking Lake Ontario, is within a short drive, as well as Syracuse, NY. The area also features a top-rated mall, superb dining options, and a wide array of outdoor activities. Nearby educational institutions include Hobart and Williams Smith Colleges and Ithaca College.
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