Group Director Case Management

Group Director Case Management

Modesto, CA

200,000 - $240,000 Signing Bonus Performance Bonus Paid Relocation

About the Role :

The Group Director Case Management is a key leadership role responsible for executing the hospital's organizational case management strategic plan across multiple hospitals. This individual serves as a leader, mentor, consultant, and subject matter expert on case management regulations and standards. The Group Director has overall responsibility for hospital utilization management, transition management, and operational management of the Case Management Department, promoting effective resource utilization, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all relevant state and federal regulations.

Key Responsibilities :

• Lead and facilitate the performance of Group Hospital Directors of Case Management regarding Level of Care, Length of Stay, and Payer Authorizations.
• Establish goals and objectives aligned with the overall strategic plans for Case Management and Utilization Review.
• Oversee Group Hospital Case Management and Utilization Review operations, ensuring 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 the selection of new Hospital Directors of Case Management and lead their orientation and onboarding.
• Maintain objectivity in decision-making, using data to support conclusions.
• Proactively anticipate and address problems and risks.
• Communicate effectively with all levels of the organization and with internal and external stakeholders.
• Direct, support, and coach direct reports.
• Develop expertise within the department and actively solicit employee input.
• Minimize staff turnover.
• Lead the 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 patient throughput and reimbursement for services.
• Ensure medical necessity and revenue cycle processes are accurate and compliant with CMS regulations and hospital 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 the management of the post-acute provider network.
• Ensure compliance with state and federal regulations and TJC accreditation standards.
• Perform other duties as assigned.

Qualifications :

Required Skills :

Benefits :

Salary : $200,000 - $240,000