RN Case Management Director: Lead Utilization & Throughput

Tenet North Cal; Modesto (CA); On-site; USD 120,000 - 170,000; Full time

Job summary

Tenet North Cal seeks an RN Case Management Director to lead the Case Management Department in Modesto, CA. The role focuses on utilization management, patient throughput, and compliance with regulatory standards.

The director will oversee coordination of care, transitions, and provider education while ensuring appropriate resource utilization and reimbursement. MSN and ACM are preferred, with extensive leadership and hospital-based case management experience required.

Qualifications

• MSN preferred; ACM preferred.
• Two years acute hospital case management leadership experience required.
• Five years acute hospital case management experience preferred.
• Demonstrated organizational, verbal and written communication skills; ability to lead diverse teams.
• Business planning experience preferred.
• Must complete Tenet’s InterQual education course within 30 days of hire (and annually thereafter) with score 85+.
• Must complete and demonstrate competency in using Tenet Case Management documentation system within 30 days of hire.
• Attendance at hospital orientation is required.
• Must work with PMI Case Management leader to complete PMI Director orientation within 90 days of hire.

Responsibilities

• Oversee hospital utilization performance improvement and operational management of the Case Management Department.
• Promote efficient patient throughput and appropriate reimbursement for services.
• Ensure compliance with state and federal regulations related to case management.
• Lead utilization management, transition management, and care coordination to optimize care delivery.
• Provide education to physicians, patients, families and caregivers per Tenet policy.

Skills

Leadership

Communication

Critical thinking

Organizational skills

Problem solving

Computer literacy

Education

MSN

ACM

Tools

McKesson InterQual

Tenet Case Management system

Job description

Tenet North Cal seeks an RN Case Management Director to lead the Case Management Department in Modesto, CA. The role focuses on utilization management, patient throughput, and compliance with regulatory standards.

The director will oversee coordination of care, transitions, and provider education while ensuring appropriate resource utilization and reimbursement. MSN and ACM are preferred, with extensive leadership and hospital-based case management experience required.