Director of Case Management

Conifer Health Solutions•Modesto, CA

1d•Onsite

About The Position

This position reports directly to the Regional Case Managment Director, Indirectly Reports to the Chief Financial Officer. 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.

Requirements

Minimum two years acute hospital case management leadership experience required.
Current and valid: Registered Nurse license, CA driver's license and proof of automotive insurance.
Ability to adjust vision sufficiently to perform duties.

Nice To Haves

MSN preferred.
Accredited Case Manager (ACM) preferred.
McKesson InterQual® experience preferred.
Five years acute hospital case management experience preferred.
Business planning experience preferred.

Responsibilities

Overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department.
Promote effective utilization of hospital resources.
Ensure processes support appropriate reimbursement for services rendered.
Support efficient patient throughput.
Ensure compliance with all state and federal regulations related to case management services.
Integrate 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.
Complete Tenet’s InterQual education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better.
Complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire.
Attend hospital orientation.
Work with regional Performance Management and Innovation (PMI) Case Management leader to complete PMI Director of Case Management orientation within 90 days of hire.