Head of Case Management Services

2 months ago

San Ramon, California, United States Veracity Full time
Head of Case Management Services

Company: Veracity


The individual in this role will oversee the comprehensive management of hospital resource utilization, transition processes, and operational leadership of the Case Management Department. The primary goal is to ensure effective use of hospital resources, maintain accurate revenue cycle operations, prevent denials, facilitate safe patient transitions, and adhere to all relevant state and federal regulations governing case management services.

This position encompasses national standards for case management service scope, including:

  • Utilization Management focused on medical necessity and denial avoidance
  • Transition Management aimed at optimizing length of stay, preventing readmissions, and enhancing patient satisfaction
  • Care Coordination ensuring efficient patient throughput while providing care in the appropriate sequence and level
  • Compliance with state and federal regulations, TJC accreditation standards, and hospital policies
  • Educational initiatives for physicians, patients, families, and caregivers
The responsibilities of the individual in this position include:

  • Managing departmental operations to ensure effective patient throughput and reimbursement for services rendered,
  • Leading the development and oversight of the hospital Utilization Management Plan, utilizing data to enhance hospital utilization performance,
  • Ensuring compliance with medical necessity and revenue cycle processes in accordance with CMS regulations and hospital policies,
  • Facilitating timely patient transitions and planning to support efficient throughput,
  • Implementing and monitoring strategies to mitigate payer disputes,
  • Developing and delivering educational content and feedback to physicians regarding hospital utilization,
  • Participating in the management of the post-acute provider network,
  • Ensuring adherence to state and federal regulations and TJC accreditation standards,
  • Performing other assigned duties as necessary.
Education Requirements

Required:
Bachelor’s degree in Business, Nursing, or Health Care Administration for RN or a Master’s in Social Work for MSW.

Preferred:
MSN, MBA, MSW, or MHA.

Experience Requirements

Required: 3 years of experience in acute hospital case management or healthcare leadership.

Preferred: 5 years of leadership experience in acute hospital case management across multiple sites.

Certification Requirements

Required:
Active Registered Nurse or LCSW/LMSW license.

Must hold a current license, certification, or registration to practice as mandated by law or regulation in the state of practice.



Preferred:
Accredited Case Manager (ACM) certification.


Essential skills include demonstrated organizational abilities, strong verbal and written communication skills, capacity to lead and coordinate diverse teams in a dynamic environment, critical thinking, problem-solving capabilities, and proficiency in computer applications.

Experience in business planning is preferred.

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