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Case Management Director
hace 1 mes
San Ramon Regional Medical Center is seeking a highly skilled and experienced Director of Case Management to lead our team in promoting 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.
Key Responsibilities:- Manage department operations to ensure 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.
- Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
- 3 years of acute hospital case management or healthcare leadership experience.
- 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.
- MSN, MBA, MSW or MHA.
- 5 years of acute hospital case management leadership multi-site experience.
- Accredited Case Manager (ACM).
San Ramon Regional Medical Center offers a competitive salary and benefits package, including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
