Director Case Management

Director Case ManagementSan Ramon, CA185K-240K + Signing Bonus + Performance Bonus + Paid RelocationJob DescriptionSUMMARY:The individual in this position has overall responsibility for hospital utilization management, transition management, and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services.This position integrates national standards for case management scope of services including:Utilization Management supporting medical necessity and denial preventionTransition Management promoting appropriate length of stay, readmission prevention, and patient satisfactionCare Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of careCompliance with state and federal regulatory requirements, TJC accreditation standards, and hospital policyEducation provided to physicians, patients, families, and caregiversThe individual’s responsibilities include the following activities:Manage department operations to assure effective throughput and reimbursement for services providedLead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvementEnsure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital policyEnsure timely and effective patient transition and planning to support efficient patient throughputImplement and monitor processes to prevent payer disputesDevelop and provide physician education and feedback on hospital utilizationParticipate in management of post-acute provider networkEnsure compliance with state and federal regulations and TJC accreditation standardsOther duties as assignedQUALIFICATIONS:Education:Required: Bachelor's degree in Business, Nursing, or Health Care Administration for RN or Master's in Social Work for MSWPreferred: MSN, MBA, MSW, or MHAExperience:Required: 3 years of acute hospital case management or healthcare leadership experiencePreferred: 5 years of acute hospital case management leadership multi-site experienceCertification:Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified, or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.Required skills include 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, and computer literacy. Business planning experience preferred.

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