Group Director of Case Management Full TIme Days

Title: Group Director of Case Management Full Time Days

Location: Modesto, CA

Job Type: FTE/Permanent

Responsibilities

Serve effectively in their current role as hospital DCM. Lead and facilitate group hospital DCMs performance for Level of Care, Length of Stay and Payer Authorizations; Lead group hospital case management 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 DCM selection and lead the orientation and onboarding process; Lead implementation and monitoring of the hospital's case management policy and regulatory requirements. Weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics; Observed/Expected Length of Stay; Authorizations and Downgrades. 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 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, and
• other duties as assigned.
  
  

Qualifications

Education:

Required: Bachelor's degree in Business, Nursing, Social Work, or Health Care Administration

Preferred: Advanced degree in business, nursing, and/or healthcare administration, health science, or related discipline

Experience

• Required: 5 years of hospital Case Management Leadership
• Preferred: 5 years of acute hospital case management leadership multi-site experience. Business planning and project management experienced.
  
  

Certifications

• 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)