Director Case Management
San Ramon, CA
185K-240K + Signing Bonus + Performance Bonus + Paid Relocation

Job Description

We 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 services

Wellbeing support, including employee assistance program (EAP)

Time away from work programs for paid time off, long- and short-term plan coverage

Savings 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 counseling

Education support through tuition assistance, student loan assistance, certification support, and online educational program

Additional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program

Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines

Benefits may vary by location and role

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 hospital policy
• Education provided to physicians, patients, families and caregivers

The 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.

QUALIFICATIONS:

Education

Required: 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.

Experience

Required: 3 years of acute hospital case management or healthcare leadership experience.

Preferred: 5 years of acute hospital case management leadership multi-site experience

Certification

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)

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.

Responsibilities

The 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 and

i) 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: MSN, MBA, MSW, or MHA

Experience:

Required: 3 years of acute hospital case management or healthcare leadership experience

Preferred: 5 years of acute hospital case management leadership multi-site experience

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)