Director Case Management
Company: The Clinical Recruiter
Location: San Ramon
Posted on: January 21, 2023
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Job Description:
(Only QUALIFIED Healthcare Professionals accepted) Case
Manager-RN - Director Case Management
San Ramon, California
JO# 30064
* Relocation Assistance *
General Summary:
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
prevention
Transition Management promoting appropriate length of stay,
readmission prevention and patient satisfaction
Care Coordination by demonstrating throughput efficiency while
assuring care is the right sequence and at appropriate level of
care
Compliance with state and federal regulatory requirements, TJC
accreditation standards and Tenet policy
Education provided to physicians, patients, families and
caregivers
The individuals 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 Tenet 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, and i) other duties as assigned.
Experience:
3 years of acute hospital case management or healthcare leadership
experiencerequired
5 years of acute hospital case management leadership multi-site
experience preferred
Education:
Bachelor degree in Business, Nursing or Health Care Administration
for RN or Master's in Social Work for MSW required
MSN, MBA, MSW or MH preferred
Certifications-Licensures:
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) coveredrequired
Accredited Case Manager (ACM)preferred
Special Skills:
Must be able to use independent decision-making skills in a wide
variety of situations
Frequent contact with employees, physicians, customers, community
individuals and volunteers
Must be self-motivated to complete work in a timely manner to meet
deadlines
Experience with Core Measures, Quality Indicators, Case Management,
and Utilization
Knowledge base of InterQual criteria
Knowledge of Managed care trends, Medicare, and Medicaid
regulations
Advanced negotiation and mediation skills
Keywords: The Clinical Recruiter, San Ramon , Director Case Management, Executive , San Ramon, California
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