Group Director of Case Management

Full Time Days

Location:
Modesto, California, United States

Summary

The Group Director Case Management is responsible for executing the hospital's organizational case management strategic plan across multiple hospitals. They are a leader, mentor, consultant, and subject matter expert regarding case management regulations and standards. 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:

Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery including the hospital's Case Management model, staffing and skill mix, complex Case Management, and centralized utilization review
Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes
Maintain objectivity in decision making, utilizes facts to support decisions
Anticipate and responds to problems and risks
Communicate effectively with all levels in the organization and with internal / external customers
Direct, support, and coach direct reports
Develop “experts” and “expertise” throughout the department and seeks employee input
Minimize staff turnover
Lead implementation and monitoring of the hospital's Case Management policy and regulatory requirements
Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, Observed / Expected Length of Stay, Authorizations and Downgrades
Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
Manage department operations to ensure effective throughput and reimbursement for services provided
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's 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

Qualifications

Education:

Required: Bachelor’s degree in business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
Preferred: Advanced degree in business, nursing and/or healthcare administration, health science or related discipline.

Experience

Required: Five (5) years of acute hospital case management or healthcare leadership experience.
Preferred: Multi-site hospital case management leadership experience, business planning and project management experience preferred.



License/Certificates/ Credentials:

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.
Preferred: Accredited Case Manager (ACM)