Director, Hospital Case Management & Utilization

Central Business Solutions, Inc; Worcester (MA); On-site; USD 119,000 - 183,000; Full time

Benefits offered by this job

Full benefits

Relocation assistance possible

Interview travel reimbursed

Job summary

Central Business Solutions, Inc is seeking a Director for Hospital Case Management in Worcester, Massachusetts. This role entails operational management, ensuring effective utilization of hospital resources, and compliance with state and federal regulations.

Key responsibilities include managing department operations, overseeing utilization management plan implementation, and ensuring timely patient transitions. The ideal candidate should possess a Bachelor's degree and relevant leadership experience in healthcare.

Qualifications

• 3 years of acute hospital case management or healthcare leadership experience.
• Registered Nurse or LCSW/LMSW license required.
• 5 years of acute hospital case management leadership multi-site experience (Preferred).

Responsibilities

• Manage department operations to assure effective throughput and reimbursement.
• Lead the implementation of the hospital Utilization Management Plan.
• Ensure medical necessity and revenue cycle processes compliance.

Skills

Hospital utilization management

Operational management

Care coordination

Regulatory compliance

Patient throughput

Education

Bachelor's degree in Business, Nursing, or Health Care Administration

MSN, MBA, MSW, or MHA (Preferred)

Job description

Director of Case Management, Worcester, MA - (IK)

• Worcester, Massachusetts

The individual in this position has overall responsibility for hospital utilization management, transition management, and operational management of the Case Management Department in order 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: 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; and Education provided to physicians, patients, families, and caregivers

Responsibilities:

• 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 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
• develop and provide physician education and feedback on hospital utilization
• other duties as assigned.

Qualifications:

• Required:
  • Education: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
  • Experience: 3 years of acute hospital case management or healthcare leadership experience
• Licensure/Certification:
  • 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:
  • Experience: 5 years of acute hospital case management leadership multi-site experience
  • Education: MSN, MBA, MSW, or MHA
  • Licensure/Certification: Accredited Case Manager (ACM)

Compensation
Base Salary -USD $119,000 to $183,000

Full-time
Benefits -Full
Relocation Assistance Available -Possible for ideal candidate
Interview Travel Reimbursed -Yes

Candidate Details
Seniority Level -Director
Management Experience Required -Yes
Minimum Education -Bachelor's Degree

Screening Questions You must answer while applying
Do you have at least 3 years of hospital (acute care) case management experience?
Do you hold an active nursing or social worker license?

Central Business Solutions, Inc(A Certified Minority Owned Organization)

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Central Business Solutions, Inc

37600 Central Court Suite 214 Newark CA, 94560

Phone: [phone] Fax: [phone]

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