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Case Management Department Head
2 months ago
The Director of Case Management Operations will be responsible for overseeing the day-to-day operations of the Case Management Department, ensuring effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services.
Key Responsibilities- 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.
- Education: Bachelor's degree in Business, Nursing, or Health Care Administration for RN or Master's in Social Work for MSW.
- Experience: 3 years of acute hospital case management or healthcare leadership experience.
- Certification: Registered Nurse or LCSW/LMSW license.
- Competitive salary range: $185K-240K per year.
- Signing bonus.
- Performance bonus.
- Paid relocation assistance.
- Comprehensive benefits package, including 401(k) matching, dental insurance, employee assistance program, flexible spending account, health insurance, life insurance, paid time off, tuition reimbursement, and vision insurance.
