Director Case Management

Director Case ManagementSan Ramon, CA185K-240K + Signing Bonus + Performance Bonus + Paid RelocationJob DescriptionThe 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 caregiversResponsibilities: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 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 acute hospital case management or healthcare leadership experience.Preferred: 5 years of acute hospital case management leadership multi-site experience.Certification: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.Job Type:

Full-timePay:

$185,000.00 - $240,000.00 per yearBenefits:401(k)401(k) matchingEmployee assistance programFlexible spending accountHealth insuranceLife insurancePaid time offRelocation assistanceVision insuranceUnless noted above, applicants MUST be authorized to work in the US without Visa Sponsorship. US citizens and Green Card holders ONLY. We do not provide relocation assistance for those living outside the continental US. Please only click apply if you meet the specific requirements of the job listing, you are able to work in the location listed, and are comfortable with the salary range indicated above. Thanks for your interest. We look forward to working with you.

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