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Director of Case Management
1 month ago
We are seeking a highly skilled and experienced Director of Case Management to lead our Case Management Department. The successful candidate will be responsible for hospital utilization management, transition management, and operational management of the department to promote 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 ensure 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.
- Required skills: demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills, and computer literacy.
- 401(k) plan with a 50% match up to 6% of pay.
- Dental insurance.
- Employee assistance program.
- Flexible spending account.
- Health insurance.
- Life insurance.
- Paid time off.
- Relocation assistance.
- Tuition reimbursement.
- Vision insurance.
We offer a competitive salary and benefits package, including a matching 401(k) plan, several health and 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 are also provided. Wellbeing support, including an employee assistance program, is available. Time away from work programs for paid time off, long- and short-term plan coverage, and savings and retirement plans, including a 401(k) plan with a 50% match up to 6% of pay, are also offered. Education support through tuition assistance, student loan assistance, certification support, and online educational programs is available. Additional benefits include life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and an employee discount program. Registered nurses are eligible for a retirement medical benefit account (RMBA) with 2% of annual eligible income set aside in accordance with program guidelines. Benefits may vary by location and role.
This is a full-time position with a competitive salary range of $185,000 to $240,000 per year. The successful candidate will be responsible for leading the Case Management Department and 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.
