Head of Case Management Operations

1 week ago

San Ramon, California, United States Knowhirematch Full time
Job Overview

Position Title: Director Case Management

Location: San Ramon, CA

Compensation: $185K - $240K + Signing Bonus + Performance Bonus + Paid Relocation

Benefits Overview:

We provide competitive compensation packages along with a variety of benefits, including a matching 401(k) plan, multiple health and dental insurance options, generous tuition assistance, and relocation support for eligible roles.

Our comprehensive benefits cover medical, prescription drugs, dental, vision, behavioral health, and telemedicine services.

We offer wellbeing resources, including an employee assistance program (EAP), and programs for time away from work that include paid time off and both long- and short-term coverage.

Retirement savings options include a 401(k) plan with a 50% match up to 6% of pay, an employee stock purchase plan, flexible spending accounts, retirement readiness tools, and financial counseling.

We also provide educational support through tuition assistance, student loan assistance, certification support, and online educational programs.

Additional benefits include life insurance, supplemental health protection plans, auto and home insurance, legal assistance, identity theft protection, and an employee discount program.

Position Summary:

The Director of Case Management is responsible for overseeing hospital utilization management, transition management, and the operational management of the Case Management Department. This role is essential in ensuring the effective use of hospital resources, timely revenue cycle processes, denial prevention, and compliance with all relevant regulations regarding case management services.

This position encompasses national standards for case management services, including:

  • Utilization Management to support medical necessity and prevent denials
  • Transition Management to promote appropriate lengths of stay, prevent readmissions, and enhance patient satisfaction
  • Care Coordination to ensure efficient patient throughput and appropriate levels of care
  • Compliance with state and federal regulations, TJC accreditation standards, and hospital policies
  • Education for physicians, patients, families, and caregivers

Key Responsibilities:

  • Manage department operations to ensure effective throughput and reimbursement for services
  • Lead the implementation and oversight of the hospital Utilization Management Plan, utilizing data to drive performance improvements
  • Ensure accurate completion of medical necessity and revenue cycle processes in compliance with regulations
  • Facilitate timely patient transitions and planning to support efficient throughput
  • Implement and monitor processes to mitigate payer disputes
  • Develop and deliver education and feedback to physicians regarding hospital utilization
  • Participate in managing the post-acute provider network
  • Ensure adherence to state and federal regulations and TJC accreditation standards
  • Perform other duties as assigned

Qualifications:

Education:

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

Preferred: MSN, MBA, MSW, or MHA.

Experience:

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:

Required: Active Registered Nurse or LCSW/LMSW license. Must be licensed, certified, or registered as required by law or regulation in the state of practice.

Preferred: Accredited Case Manager (ACM).

Skills:

Demonstrated organizational skills, excellent verbal and written communication abilities, capacity to lead and coordinate diverse teams in a fast-paced environment, critical thinking, problem-solving skills, and computer literacy are essential. Business planning experience is preferred.

Job Type: Full-time

Compensation: $185,000 - $240,000 per year

Benefits Include:

  • 401(k) with matching
  • Dental and health insurance
  • Employee assistance program
  • Flexible spending account
  • Life insurance
  • Paid time off
  • Relocation assistance
  • Tuition reimbursement
  • Vision insurance

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