Director of Case Management and Utilization

6 days ago


San Ramon California, United States Executive Human Resource Service Full time
Job Summary

We are seeking a highly skilled and experienced Director of Case Management and Utilization to join our team at Executive Human Resource Service. As a key member of our healthcare leadership team, you will be responsible for leading and managing the case management department, ensuring that patients receive the necessary care in a timely and cost-effective manner.

Key Responsibilities
  • Develop and implement case management programs to optimize patient outcomes
  • Supervise case management staff and collaborate with other healthcare providers to ensure effective care delivery
  • Ensure compliance with all relevant regulations and standards, including CMS regulations and hospital policy
  • 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 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
  • Active RN or LCSW/LMSW license for state(s) covered
  • Preferred: Accredited Case Manager (ACM)
What We Offer

Full benefits provided

How to Apply

Please send resumes in Word Document Format or Email a Word Attachment Only. No PDF Files Please



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