Director of Case Management and Utilization
6 days ago
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
- 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)
Full benefits provided
How to ApplyPlease send resumes in Word Document Format or Email a Word Attachment Only. No PDF Files Please
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