Job Title : Case Management Director
Job Location : San Ramon, CA
Salary Range : $185,000.00 - $240,000.00 per year
Benefits :Job Description :
We provide a competitive salary and benefits package, including a matching 401(k), multiple health & dental plans, generous tuition assistance, and relocation support for eligible roles.
Our comprehensive benefits range from medical and prescription drug coverage to dental, vision, and behavioral health services.
We also offer wellbeing support through our employee assistance program (EAP) and time away from work programs.
Save for retirement with our 401(k) Plan, which includes a 50% match up to 6% of your pay. Take advantage of our education support programs, such as tuition assistance and student loan assistance.
We even offer additional benefits like life insurance, supplemental health protection plans, and employee discounts.
In this role as Case Management Director, you will be responsible for overseeing hospital utilization management, transition management, and operational management of the Case Management Department.
Your main objective will be to ensure effective utilization of hospital resources, accurate revenue cycle processes, denial prevention, and safe patient throughput.
Compliance with state and federal regulations related to case management services is also essential.
To succeed in this position, you will need to integrate national standards for case management services, including utilization management, transition management, care coordination, compliance, and education.
Some of your key responsibilities will include managing department operations, implementing and overseeing the hospital Utilization Management Plan, ensuring medical necessity and revenue cycle compliance, facilitating patient transition, preventing payer disputes, providing physician education, and participating in post-acute provider network management.
Qualifications : Education :
Education :
- Required : Bachelor's degree in Business, Nursing, or Health Care Administration (for RN) -or- Master's degree in Social Work (for MSW)
- Preferred : MSN, MBA, MSW, or MHA
Experience :
- Required : At least 3 years of acute hospital case management or healthcare leadership experience
- Preferred : At least 5 years of acute hospital case management leadership experience across multiple sites
Certification :
- Required : Registered Nurse or LCSW / LMSW license
- Preferred : Accredited Case Manager (ACM)
Additional Skills :
In addition to the qualification requirements, you should possess strong organizational, communication, leadership, critical thinking, problem-solving, and computer literacy skills.
Previous business planning experience is preferred.
Responsibilities :
- Manage department operations to ensure effective patient throughput and reimbursement
- Implement and oversee the hospital Utilization Management Plan to drive performance improvement
- Ensure compliance with CMS regulations and hospital policy regarding medical necessity and revenue cycle processes
- Facilitate timely and efficient patient transition and planning
- Monitor processes to prevent payer disputes
- Provide education and feedback to physicians regarding hospital utilization
- Participate in the management of post-acute provider network
- Ensure compliance with state and federal regulations and TJC accreditation standards
- Perform other duties as assigned
Job Type : Full-time
This position requires relocation to San Ramon, CA. A signing bonus and performance bonus are available, as well as paid relocation assistance for eligible candidates.
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