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:

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 experience. Preferred: 5 years of acute hospital case management leadership experience, including multi-site experience. Business planning and project management experience preferred. Certifications: Required: Registered Nurse (RN) or LCSW/LMSW license. Must be currently licensed, certified, or registered to practice profession as required by law or regulation in the state of practice. Active RN or LCSW/LMSW license for the state(s) covered. Preferred: Accredited Case Manager (ACM)

Required Skills:

Demonstrated organizational skills. Excellent verbal and written communication skills. Ability to lead and coordinate activities of a diverse group of people in a fast-paced environment. Critical thinking and problem-solving skills. Computer literacy. Business planning experience preferred.

Benefits:

401(k) with matching Dental insurance Employee assistance program Flexible spending account Health insurance Life insurance Paid time off Tuition reimbursement Vision insurance Comprehensive medical, prescription drug, dental, vision, behavioral health, and telemedicine services Wellbeing support, including EAP Time away from work programs Savings and retirement plans Education support Additional benefits including life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program For RNs: Retirement medical benefit account (RMBA)