Director of Case Management
About the hospital
For more than 35 years, our has provided quality medical care from a well-integrated medical campus that serves Lakewood, Artesia, Cerritos, Bellflower, Downey, Long Beach and Paramount. The hospital is accredited by The Joint Commission. Our client is a 172-bed, acute-care facility. Specializations include: A Primary Stroke Center, award-winning heart care services, 24-hour emergency care, with online check-in, bloodless medical care and surgery and MedPost urgent care location.
About the position
The Director of Case Management has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department 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
- Education provided to physicians, patients, families and caregivers
The individual’s responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, , g) ensure compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.
- Active Registered Nurse license with at least two years acute hospital case management leadership experience.
- BSN required; MSN preferred.
- Accredited Case Manager (ACM) preferred.
- McKesson InterQual® experience preferred.
- Five years acute hospital case management experience preferred.
- Demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills and computer literacy.
- Business planning experience preferred.