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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.
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
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)
Job Type: Full-time
Benefits:
Full Time
Scientific Services
$157k-211k (estimate)
06/22/2024
08/22/2024
impact-solutions.co.uk
GRANGEMOUTH, SCOTLAND
25 - 50
2002
KEVIN ROSS
<$5M
Scientific Services
The job skills required for Group Director Case Management include Case Management, Leadership, Planning, Social Work, Utilization Management, Problem Solving, etc. Having related job skills and expertise will give you an advantage when applying to be a Group Director Case Management. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Group Director Case Management. Select any job title you are interested in and start to search job requirements.