Description
Group Director of Case Management
Manteca CA Region
Access to more than 600 physicians
Employs more than 2,600 people and is served by over 180 volunteers
Treats more than 100,000 emergency patients each year
Admits more than 22,000 patients annually
The largest hospital between Stockton and Fresno
Position Description:
The Group Director Case Management is responsible for executing 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 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:
Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery including the Tenet Case Management model, staffing and skill mix, complex Case Management, and centralized utilization review
Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes
Maintain objectivity in decision making, utilizes facts to support decisions
Anticipate and responds to problems and risks
Communicate effectively with all levels in the organization and with internal / external customers
Direct, support, and coach direct reports
Develop “experts” and “expertise” throughout the department and seeks employee input
Minimize staff turnover
Lead implementation and monitoring of Tenet 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 throughput and reimbursement for services provided
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
Qualifications
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)
Compensation
Base Salary - USD $150,000 to $235,000
Relocation Assistance Available
Interview Travel Reimbursed
Benefit Offered:
They 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
Wellbeing support, including employee assistance program (EAP)
Time away from work programs for paid time off, long- and short-term plan coverage
Savings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling
Education support through tuition assistance, student loan assistance, certification support, and online educational program
Additional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program
Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines
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