Director - Case Management

Saint Vincent Hospital; Worcester (MA); On-site; USD 118,560 - 183,040; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) retirement savings plan

Generous paid time off

Career development opportunities

Job summary

A leading healthcare facility in Worcester is seeking a qualified leader to oversee the Case Management Department. This role includes driving operational success and improving patient outcomes through effective utilization management and compliance with regulations. Candidates should possess a Bachelor's degree in Business, Nursing, or a related field along with a valid RN or LCSW/LMSW license. The position offers competitive compensation ranging from $118,560 to $183,040 depending on experience and qualifications.

Qualifications

• 3 years of acute hospital case management or healthcare leadership experience.
• Current RN or LCSW/LMSW license.
• Ability to manage department operations effectively.

Responsibilities

• Manage department operations for effective throughput.
• Lead the implementation of the hospital Utilization Management Plan.
• Ensure compliance with CMS regulations.
• Develop education for physicians on hospital utilization.

Skills

Healthcare leadership

Utilization management

Patient throughput

Team management

Education

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

Master's in Social Work

Job description

Overview

Are you a results‑driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Saint Vincent Hospital we are seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

Job Summary

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, transition management, care coordination, compliance with regulations, and education.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status.

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 the profession as required by law or regulation in the 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).

Salary

$118,560 - $183,040. Individual wages are determined based upon a number of factors including, but not limited to, an individual’s qualifications and experience. Calculated based on a full time position.

Employment Practices

Employment practices will not be influenced or affected by an applicant’s or employee’s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.

Tenet participates in the E‑Verify program. Additional information: E‑Verify: http://www.uscis.gov/e-verify.