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Director of Case Management
4 months ago
Job Title: Director of Case Management
Location: San Ramon, CA
Position Type: Permanent
Salary Up to $230,000 + Benefits
Job Description:
- Manage department operations to assure effective throughput and reimbursement for services provided,
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
- Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital policy,
- Ensure timely and effective patient transition and planning to support efficient patient throughput,
- Implement and monitor processes to prevent payer disputes,
- Develop and provide physician education and feedback on hospital utilization,
- Participate in management of post-acute provider network,
- Ensure compliance with state and federal regulations and TJC accreditation standards and
- Other duties as assigned.
Qualifications Education:
- Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW Required.
- MSN, MBA, MSW, or MHA Preferred.
Experience:
- 3 years of acute hospital case management or healthcare leadership experience Required.
- 5 years of acute hospital case management leadership multi-site experience Preferred.
Certifications:
- Registered Nurse or LCSW/LMSW license.
- Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.
- Active RN or LCSW/LMSW license for state(s) covered.
Preferred:
- Accredited Case Manager (ACM)
Physical Demands:
- Lift/position up to 25 lbs.
- Push/pull up to 25 lbs. of force. Frequent sitting.
- Moderate standing, walking, reaching, stooping, and bending.
- Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.
Must-Haves:
- 5+ to 7 years’ experience
- Minimum Education Bachelor's Degree
- Willingness to Travel Occasionally
