Director of Case Management at Jackson Health System

Jackson Behavioral Health Hospital

Department: Mental Health Case Management

Address: 1695 NW 9th Avenue, Miami, Florida 33136

Shift Details: Full-Time Days

Summary

The Director of Social Work and Case Management provides strategic and operational leadership for the Social Work, Case Management, and Utilization Review departments within a psychiatric hospital setting. This position oversees inpatient social work services, emergency department social work services, discharge planning, care coordination, utilization management, and payer authorization processes.

The Director is responsible for ensuring high-quality patient care, regulatory compliance, effective discharge planning, appropriate level-of-care determinations, medical necessity compliance, reimbursement optimization, and efficient patient flow throughout the hospitalization process. The position collaborates closely with physicians, nursing leadership, clinical departments, managed care organizations, and community providers to achieve positive clinical, operational, and financial outcomes.

Technical Skills

• Knowledge of behavioral health regulations, accreditation standards, and regulatory requirements.
• Knowledge of utilization management principles, medical necessity criteria, and reimbursement methodologies.
• Knowledge of discharge planning, care coordination, and community resource development.
• Ability to lead and supervise multidisciplinary teams.
• Ability to analyze operational and clinical data to improve outcomes and performance.
• Ability to develop and manage departmental budgets and resources.
• Strong communication, collaboration, problem-solving, and conflict resolution skills.
• Ability to establish strategic goals, implement initiatives, and monitor performance outcomes.

Responsibilities

• Provides leadership and oversight for the Inpatient Social Work Department and Emergency Department Social Work Services.
• Directs all Case Management and Utilization Review operations.
• Ensures patients meet medical necessity criteria and appropriate level-of-care determinations.
• Oversees concurrent review, payer authorization, denial prevention, and appeals processes.
• Monitors compliance with federal, state, accreditation, and payer requirements, including CMS, Joint Commission, and managed care standards.
• Leads discharge planning and transition-of-care activities to promote timely and appropriate patient placement and reduce barriers to discharge.
• Provides leadership in managed care operations for the Jackson Health System.
• Directs the Case Management, Utilization Management, Disease Management, and Renal Management Programs.
• Develops, implements, and manages various disease management programs, including the PSN Disease Management Program, Medipass Disease Management Program for Diabetes, CHF, Hypertension, and Asthma, CAP Disease Management Program, and the SFCCN AIDS DMI Project for Miami-Dade County.
• Directs and manages the concurrent review process for PSN patients within the Jackson Health System.
• Provides leadership regarding clinical compliance activities, including the PRO activities, Clinical Compliance Program, and Medicare 7th Scope of Work.
• Oversees prospective payment systems related activities for both inpatient and outpatient care.
• Co-directs the countywide Medical Management Program during disasters. Directs and manages the Medical Foster Care Case Management Program.
• Performs all other related job duties as assigned.

Experience

• Generally requires 7 to 10 years of related experience. Management experience is required.

Education

• Bachelor's degree in related field is required. Master's degree is strongly preferred. Employees hired into this position before January 2017 are grandfathered in to RN requirement.

Credentials

• Valid Florida RN license is required. Case Management certification is preferred. Employees hired into this position before January 2017 are grandfathered in to RN License requirement.

Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.