Director of Case Management

20 hours ago


San Ramon, California, United States Crescent City Recruitment Group Full time
Job Summary

We are seeking a highly skilled and experienced Director of Case Management to join our team at Crescent City Recruitment Group. As a key member of our healthcare leadership team, you will be responsible for overseeing the Case Management Department and ensuring effective utilization of hospital resources, timely and accurate revenue cycle processes, 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
Requirements
  • Bachelor's degree in Business, Nursing, or Health Care Administration for RN or Master's in Social Work for MSW
  • 3 years of acute hospital case management or healthcare leadership experience
  • Registered Nurse or LCSW/LMSW license
  • Active RN or LCSW/LMSW license for state(s) covered
Preferred Qualifications
  • MSN, MBA, MSW, or MHA
  • 5 years of acute hospital case management leadership multi-site experience
  • Accredited Case Manager (ACM)
Benefits
  • Competitive salary range: $185,000 - $240,000 per year
  • 401(k) matching
  • Dental insurance
  • Employee assistance program
  • Flexible spending account
  • Health insurance
  • Life insurance
  • Paid time off
  • Relocation assistance
  • Tuition reimbursement
  • Vision insurance


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