OPEN JOB: Director of Case Management LOCATION: Palm Springs, California **Relocation Available SALARY: $129,000 to $200,000 **This position qualifies for a $20,000 Sign-On Bonus!
SUMMARY:
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:
Utilization Management supporting medical necessity and denial prevention
Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
Compliance with state and federal regulatory requirements, TJC accreditation standards and hospital policy
Education provided to physicians, patients, families and caregivers
The individual’s responsibilities include the following activities:
Manage department operations to assure effective throughput and reimbursement for services provided
Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet 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
QUALIFICATIONS:
REQUIRED: Registered Nurse or LCSW/LMSW license.
Preferred: Accredited Case Manager (ACM)
REQUIRED: Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
Preferred: MSN, MBA, MSW or MHA.
REQUIRED: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience
If you are interested in pursuing this opportunity, please respond back and include the following:
MS WORD Resume
required compensation.
Contact information.
Availability
Upon receipt, one of our managers will contact you to discuss the position in full detail.