Case Management Director with Acute Care Experience
3 weeks ago
Job Summary:
The Director of Case Management will oversee the hospital's utilization management, transition management, and operational management of the Case Management Department. This role is responsible for promoting effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with 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.
Qualifications:
- Education: Bachelor's degree in Business, Nursing, or Healthcare Administration for RN or Master's in Social Work for MSW.
- Experience: 3 years of acute hospital case management or healthcare leadership experience.
- Certification: Registered Nurse or LCSW/LMSW license.
Preferred Qualifications:
- MSN, MBA, MSW, or MHA.
- 5 years of acute hospital case management leadership multi-site experience.
- Accredited Case Manager (ACM) certification.
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.
- Computer literacy.
Business Planning Experience Preferred:
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