Group Director Case Management

Group Director Case Management Supervisor

Modesto, CA

Salary : 150-200K + Signing Bonus + Performance Bonus + Paid Relocation

We are seeking a competent and dedicated individual for the role of Group Director Case Management Supervisor. This position will be based in Modesto, CA.

The Group Director Case Management Supervisor will be responsible for overseeing the implementation of the hospital's case management strategic plan across multiple hospitals.

They will act as a mentor and consultant, ensuring that the case management department adheres to all relevant regulations and standards.

In addition, this individual will oversee utilization management, transition management, and operational management of the department.

The goal of this role is to ensure efficient utilization of hospital resources, accurate revenue cycle processes, timely patient throughput, and compliance with state and federal regulations.

• This position involves integrating national standards for case management services
• Oversee the performance of hospital Directors of Case Management in areas such as Level of Care, Length of Stay, and Payer Authorizations
• Establish goals and objectives that align with the strategic plans of the Case Management and Utilization Review strategy
• Lead case management and utilization review operations for cost-effective and clinically sound care delivery
• Play a key role in the selection and onboarding of new hospital Directors of Case Management
• Make objective decisions based on facts
• Identify and address problems and risks proactively
• Communicate effectively with stakeholders at all levels
• Provide leadership, support, and coaching to direct reports
• Foster expertise and development within the department
• Prioritize employee retention
• Ensure compliance with the hospital's case management policy and regulatory requirements
• Review and analyze Case Management Scorecard metrics on a weekly basis
• Oversee the implementation and monitoring of the hospital's Utilization Management Plan
• Manage department operations to optimize throughput and reimbursement
• Ensure accurate and compliant medical necessity and revenue cycle processes
• Facilitate effective patient transition and planning
• Implement and monitor processes to prevent payer disputes
• Provide physician education and feedback on hospital utilization practices
• Contribute to the management of the post-acute provider network
• Maintain compliance with state and federal regulations and accreditation standards
• Perform any other duties as assigned

Responsibilities

The Group Director Case Management Supervisor will serve as a hospital DCM and lead the performance of group hospital DCMs in areas such as Level of Care, Length of Stay, and Payer Authorizations.

They will oversee case management operations, including staffing, skill mix, complex case management, and centralized utilization review.

Additionally, they will participate in the selection and onboarding processes for new hospital DCMs. The individual in this role will be responsible for implementing and monitoring the hospital's case management policy and regulatory requirements.

They will also review and analyze weekly Case Management Scorecard metrics. Specifically, the responsibilities of this role include :

a) Managing department operations to optimize throughput and reimbursement for services provided

b) Leading the implementation and oversight of the hospital's Utilization Management Plan

c) Ensuring accurate and compliant medical necessity and revenue cycle processes

d) Facilitating effective patient transition and planning

e) Implementing and monitoring processes to prevent payer disputes

f) Providing physician education and feedback on hospital utilization practices

g) Contributing to the management of the post-acute provider network

h) Ensuring compliance with state and federal regulations and accreditation standards

i) Other duties as assigned

We offer a competitive salary and a comprehensive benefits package, including a matching 401(k), multiple health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.

Our benefits package includes :

• Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine services
• Wellbeing support, including an employee assistance program (EAP)
• Time off programs for paid time off and long- and short-term plan coverage
• Savings and retirement options, 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 programs
• Additional benefits such as life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and an employee discount program
• Retirement medical benefit account (RMBA) for registered nurses 2% of annual eligible income set aside in accordance with program guidelines
• Benefits may vary by location and role

Education :

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

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

Experience :

Required : Five (5) years of hospital case management or healthcare leadership experience

Preferred : Multi-site hospital case management leadership experience, business planning and project management experience

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)

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.

Qualifications : Education :

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 or healthcare leadership

Preferred : 5 years of acute hospital case management leadership multi-site experience. Business planning and project management experience preferred.

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)

Job Type : Full-time

Benefits :

• 401(k) retirement plan
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

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