Director Case Management

Healthcare Recruitment Partners • Coachella, CA

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About The Position

RN Director Case Management Coachella Valley, CA The Director of Case Management supports the advancement of Case Management. The Director of Case Management performs the functions necessary to support Case Management strategy. The Director of Case Management is responsible for h ospital Utilization Management, Transition Management, and operational management of the Case Management Department. The Director of Case Management promotes 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.

Requirements

• Registered Nurse required
• Bachelor’s Degree in Nursing or Bachelor’s Degree in Healthcare required
• Director of Case Management experience in an Acute Hospital setting

Nice To Haves

• Master’s Degree preferred
• Certified Case Management (CCM) or Accredited Case Manager (ACM) certification preferred

Responsibilities

• Leads implementation and oversight of the hospital Utilization Management Plan, using data to drive utilization performance improvement
• Ensures medical necessity reviews and revenue cycle processes are completed accurately and in compliance with CMS regulations
• Oversees timely and effective patient transitions and discharge planning to support efficient throughput and patient satisfaction
• Manages department operations to optimize throughput, reimbursement, and resource utilization for services provided
• Implements and monitors processes to prevent payer disputes and denials
• Develops and delivers physician education and feedback on hospital utilization and documentation
• Participates in management of the post-acute provider network
• Ensures compliance with state and federal regulations, TJC accreditation standards, and evidence-based practices
• Supports Utilization Management for medical necessity determination and denial prevention
• Drives Transition Management to promote appropriate length of stay, readmission prevention, and patient satisfaction
• Facilitates Care Coordination to ensure throughput efficiency and care delivered in the right sequence at the appropriate level
• Provides education to physicians, patients, families, and caregivers on care management processes and expectations

What This Job Offers

• Job Type: Full-time
• Career Level: Director