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Director of Case Management
1 month ago
Director of Case Management
Executive Human Resource Service, a Certified Women Minority Owned Business Enterprise, is seeking a highly skilled and experienced Director of Case Management to lead and manage the case management department.
The ideal candidate will have a strong background in healthcare leadership, with a focus on case management and utilization management. They will be responsible for developing and implementing case management programs, supervising case management staff, and collaborating with other healthcare providers to optimize patient outcomes.
The Director of Case Management will ensure compliance with all relevant regulations and standards, while working to improve the quality and efficiency of care delivery. They will also be responsible for hospital utilization management, transition management, and operational management of the Case Management Department.
The successful candidate will have a strong understanding of national standards for case management scope of services, including utilization management, transition management, care coordination, and compliance with state and federal regulations.
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
Requirements
- Bachelor's Degree in Business, Nursing, or Health Care Administration for RN or Master's in Social Work for MSW
- Three (3) years of acute hospital case management or healthcare leadership experience
- Preferred: Five (5) years of acute hospital case management leadership multi-site experience
- Registered Nurse or LCSW/LMSW license
- Preferred: Accredited Case Manager (ACM)
What We Offer
Executive Human Resource Service offers a competitive salary and benefits package, including full benefits provided.
How to Apply
Please send your resume in Word Document Format or Email a Word Attachment Only. No PDF Files Please. Send resumes email to: Executive Human Resource Service. Website: Note: Please Reference - Job Title and Job Number.
