Nurse Director, Case Management - San Ramon,

Our facility provides comprehensive inpatient and outpatient services.

Job Benefits:

• 401(k) 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.


• Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine benefits.


• Wellbeing support through an Employee Assistance Program (EAP).


• Paid time off and long- and short-term disability coverage.


• Education support including tuition assistance, student loan assistance, certification support, and online educational programs.

Responsibilities:

• Oversee department operations to ensure effective throughput and reimbursement for services provided.


• Lead the implementation and oversight of the hospital Utilization Management Plan, using data to drive performance improvement.


• Ensure compliance with CMS regulations and hospital policy regarding medical necessity and revenue cycle processes.


• Manage patient transitions 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 the management of the post-acute provider network.


• Ensure compliance with state and federal regulations and TJC accreditation standards.