Director of Case Management

3 weeks ago

San Ramon, United States ALOIS Healthcare Full time

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

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