Group Director of Case Management Full Time Days

3 weeks ago

Modesto, United States Doctors Medical Center of Modesto Full time

**Doctors Medical Center of Modesto**

Doctors Medical Center Modesto is a full-service, comprehensive health care facility, dedicated to providing the finest medical care for the community. From preventative and diagnostic services to expertise in some of the world's leading technologies, DMC's multidisciplinary team of physicians and healthcare professionals is dedicated to your good health and well-being. Recognized for innovative cardiac and neonatal intensive care to advanced stroke and trauma treatment, the outstanding doctors at DMC represent most major medical specialties and are committed to being there for you, when you need them most.

We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
- **Comprehensive benefits** for medical, prescription drug, dental, vision, behavioral health and telemedicine services
- **Wellbeing **support, including employee assistance program (EAP)
- **Time away from work** programs for paid time off, long
- and short-term plan coverage
- **Savings and retirement** including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling
- **Education **support through tuition assistance, student loan assistance, certification support, and online educational program
- **Additional benefits** life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program
- **Registered nurses - **Retirement medical benefit account (RMBA) - 2% of annual eligible income set aside in accordance with program guidelines
- **Benefits may vary by location and role**

**Summary**

This position integrates national standards for case management scope of services including:

- Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
- Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
- Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery including the Tenet Case Management model, staffing and skill mix, complex Case Management, and centralized utilization review
- Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes
- Maintain objectivity in decision making, utilizes facts to support decisions
- Anticipate and responds to problems and risks
- Communicate effectively with all levels in the organization and with internal / external customers
- Direct, support, and coach direct reports
- Develop “experts” and “expertise” throughout the department and seeks employee input
- Minimize staff turnover
- Lead implementation and monitoring of Tenet Case Management policy and regulatory requirements
- Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, Observed / Expected Length of Stay, Authorizations and Downgrades
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
- Manage department operations to ensure effective throughput and reimbursement for services provided
- Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet 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
- Other duties as assigned

**Qualifications**

**Education**:
Required: Bachelor’s degree in business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
Preferred: Advanced degree in business, nursing and/or healthcare administration, health science or related discipline.

**Experience**

Required: Five (5) years of acute hospital case management or healthcare leadership experience.
Preferred: Multi-site hospital case management leadership experience, business planning and project management experience preferred.

**License/Certificates/ Credentials**:
Required: 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)

Required skills include demonstrated organizational skills, excellent verbal and wri

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