Group Director of Case Management Full TIme Days

---

Job description

Title: Group Director of Case Management Full Time Days

Location: Modesto, CA

Job Type: FTE/Permanent

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.

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 description page –>