Director Case Management

Director Case ManagementSan Ramon, CA185K-240K + Signing Bonus + Performance Bonus + Paid RelocationJob DescriptionWe offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine servicesWellbeing support, including employee assistance program (EAP)Time away from work programs for paid time off, long- and short-term plan coverageSavings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counselingEducation support through tuition assistance, student loan assistance, certification support, and online educational programAdditional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount programRegistered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelinesBenefits may vary by location and roleSUMMARY: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 provided,lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital policy,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,other duties as assigned.RequirementsQUALIFICATIONS:EducationRequired: 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.ExperienceRequired: 3 years of acute hospital case management or healthcare leadership experience.Preferred: 5 years of acute hospital case management leadership multi-site experienceCertificationRequired: 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.Preferred: Accredited Case Manager (ACM)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.ResponsibilitiesThe individual’s responsibilities include the following activities:a) manage department operations to assure effective throughput and reimbursement for services provided,b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital policy,d) ensure timely and effective patient transition and planning to support efficient patient throughput,e) implement and monitor processes to prevent payer disputes,f) develop and provide physician education and feedback on hospital utilization,g) participate in management of post-acute provider network,h) ensure compliance with state and federal regulations and TJC accreditation standards andi) other duties as assigned.QualificationsEducation: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 experienceRequired: 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.Preferred: Accredited Case Manager (ACM)Job Type: Full-timeBenefitsPay: $185,000.00 - $240,000.00 per yearBenefits:401(k)401(k) matchingDental insuranceEmployee assistance programFlexible spending accountHealth insuranceLife insurancePaid time offRelocation assistanceTuition reimbursementVision insurance