Group Director Case Management
Modesto, CA
150-200K Signing Bonus Performance Bonus Paid Relocation

The Group Director Case Management is responsible for executing the hospital's organizational case management strategic plan across multiple hospitals. They are a leader, mentor, consultant, and subject matter expert regarding case management regulations and standards. 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:
• Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
• Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
• Lead Group hospital Case Management and Utilization Review 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 Director of Case Management selection and lead the orientation and onboarding processes
• Maintain objectivity in decision making, utilizes facts to support decisions
• Anticipate and responds to problems and risks
• Communicate effectively with all levels in the organization and with internal / external customers
• Direct, support, and coach direct reports
• Develop “experts” and “expertise” throughout the department and seeks employee input
• Minimize staff turnover
• Lead implementation and monitoring of the hospital's Case Management policy and regulatory requirements
• Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, Observed / Expected Length of Stay, Authorizations and Downgrades
• Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
• Manage department operations to ensure effective throughput and reimbursement for services provided
• 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
• Other duties as assigned

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:

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 the hospital's 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.

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

Education:

Required: Bachelor’s degree in business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.

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

Experience

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

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

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:

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)