DIRECTOR, CASE MANAGEMENT

Direct Staffing Inc; Lakewood (CO); On-site; USD 85,000 - 120,000; Full time

Job summary

A healthcare staffing agency is seeking a Case Management Director in Lakewood, Colorado, responsible for leading hospital utilization performance improvement and operational management of the Case Management Department. The role requires a current RN license and at least five years of acute care experience with two years in a leadership position. Responsibilities include managing department operations, ensuring compliance with regulations, and developing education for staff. This position is vital for promoting effective hospital resource utilization and ensuring patient care quality.

Qualifications

• Current CA RN license is required.
• Must have 5 years of acute care experience.
• Two years of leadership in acute hospital case management is needed.
• Demonstrated organizational skills are essential.
• Excellent verbal and written communication skills required.
• Ability to lead diverse groups in a fast-paced environment needed.
• Critical thinking and problem-solving skills necessary.

Responsibilities

• Manage department operations to assure effective throughput and reimbursement.
• Lead hospital Utilization Management Plan implementation.
• Ensure accurate medical necessity review processes.
• Support timely patient transition and planning.
• Monitor processes to prevent payer disputes.
• Develop and provide education on hospital utilization.
• Ensure compliance with regulations and standards.

Skills

Organizational skills

Excellent verbal and written communication

Critical thinking

Problem solving

Education

Current CA RN license

5 years acute care experience

Two years acute hospital case management leadership

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.

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 Tenet 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 review 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
• ensure compliance with state and federal regulations and TJC accreditation standards
• other duties as assigned

Qualifications

• Current CA RN license
• 5 years acute care experience
• Two years acute hospital case management leadership
• Demonstrated organizational skills
• Excellent verbal and written communication skillsAbility to lead and coordinate activities of a diverse group of people in a fast paced environment
• Critical thinking and problem solving skills

Screening Questions

• Does the candidate have an RN license?
• Does the candidate have Director level experience in Case Management?

Additional Information

All your information will be kept confidential according to EEO guidelines.

Direct Staffing Inc

Job Location