Title: Director of Case management
Location: Lakewood, CA
Type: Permanent
Job description:
The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput and ensure compliance with all state and federal regulations related to case management services.
The 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 Tenet policy
• Education provided to physicians, patients, families and caregivers
Job responsibilities:
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 review processes are completed accurately and in
Compliance with CMS regulations and Tenet 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) Ensure compliance with state and federal regulations and TJC accreditation standards
h) Other duties as assigned.
Required Qualification:
• Current CA RN license
• 5 years acute care experience
• Two years acute hospital case management leadership
• McKesson InterQual® experience
• 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
Required Qualification:
• Current CA RN license
• 5 years acute care experience
• Two years acute hospital case management leadership
• McKesson InterQual® experience
• 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
Please help pass along to colleagues or associates below position who are looking for new role if you are not available.
For further details contact me at
chaitanya (at) mitresource (dot) com
Thank you for your time.
Job details are sourced from the employer's original posting.
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