Director Case Management

Company: The Clinical Recruiter
Location: San Ramon
Posted on: January 21, 2023

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