Group Director of Case Management

---

Job description

Title: Group Director of Case Management

Location: Modesto, CA

Job Type: FTE/Permanent

Shift: Full Time Days

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.

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)

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

<!– job description page –>