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Group Director Case Management Lead
4 weeks ago
We are seeking a highly experienced and skilled Group Director Case Management to lead our Case Management Department in Modesto, CA. As a key member of our leadership team, you will be responsible for executing the hospital's organizational case management strategic plan across multiple hospitals.
Key Responsibilities- Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
- Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
- Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery
- Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes
- Maintain objectivity in decision making, utilizes facts to support decisions
- Anticipate and responds to problems and risks
- Communicate effectively with all levels in the organization and with internal / external customers
- Direct, support, and coach direct reports
- Develop experts and expertise throughout the department and seeks employee input
- Minimize staff turnover
- Lead implementation and monitoring of the hospital's Case Management policy and regulatory requirements
- Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, Observed / Expected Length of Stay, Authorizations and Downgrades
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
- Manage department operations to ensure effective throughput and reimbursement for services provided
- Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's 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
- 5 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
- Accredited Case Manager (ACM) certification preferred
- Competitive salaries and benefits
- Matching 401(k) plan
- Several health & dental plans to choose from
- Generous tuition assistance plans
- Relocation assistance for select positions
