PostJobMatches By WorkStaff USA is a leading staffing agency in the job placement industry, providing top-notch professionals to facilities across the country. Our team of experienced recruiters work together to match the best candidates with the right job and/or business opportunities.

Today we are hiring a RN, Director of Case Management for our client for this Full Time Days position. This client is a leading health system and services platform that continues to evolve in lockstep with community need. The hospital's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.

Their impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. They are differentiated by their top-notch medical specialists and service lines that are tailored within each community they serve. The work Conifer they are doing will help provide the foundation for better health for patients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.

Together as an enterprise, they all work to save lives and will accept nothing less than excellence in service of their patients and their families, every day.

This well-known Medical Center began serving residents of the San Ramon Valley and its surrounding communities in 1990. Located on a hillside overlooking the valley, they are a 123-bed, acute-care hospital, primary stroke center, and a Cardiac heart surgery hospital. This Medical Center provides comprehensive inpatient and outpatient services. Personalized service and a patient-centered philosophy are distinctive qualities of their facility.

Offering competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.

Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and tele-medicine services.

Well-being support, including employee assistance program (EAP)

Time away from work programs for paid time off, long- and short-term plan coverage

Savings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling

Education support through tuition assistance, student loan assistance, certification support, and online educational program

Additional benefits:

Life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program

Registered nurses Retirement medical benefit account (RMBA) 2% of annual eligible income set aside in accordance with program guidelines

Benefits may vary by location and role, but we are holding outstanding benefits for all of our staff.

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 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 hospital policy

Education provided to physicians, patients, families and caregivers




The individuals responsibilities include the following activities:

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 hospital policy,

Ensure timely and effective patient transition and planning to support efficient patient throughput,

Implement and monitor processes to prevent payer disputes,

Develop and provide physician education and feedback on hospital utilization,

Participate in management of post-acute provider network,

Ensure compliance with state and federal regulations and TJC accreditation standards,

Other duties as assigned.




Education Required:

Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.

Preferred: MSN, MBA, MSW or MHA.

Experience Required:

3 years of acute hospital case management or healthcare leadership experience.

Preferred: 5 years of acute hospital case management leadership multi-site experience

Certification Required:

Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.

Preferred: Accredited Case Manager (ACM)

Required skills:

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.

Physical Demands:

Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force.

Frequent sitting. Moderate standing, walking, reaching, stooping, and bending

Manual dexterity, mobility, touch, auditory to perform all the related duties of the position

Pay Range: $68.58 - $109.71 Hourly

Individual wages are determined based upon a number of factors including, but not limited to, an individuals qualifications and experience

The hospital complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Responsibilities:

The individuals 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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital 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) participate in management of post-acute provider network,

h) ensure compliance with state and federal regulations and TJC accreditation standards and

i) other duties as assigned.

Education Qualifications:

Required: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW

Preferred: MSN, MBA, MSW, or MHA

Experience:

Required: 3 years of acute hospital case management or healthcare leadership experience

Preferred: 5 years of acute hospital case management leadership multi-site experience

Certifications:

Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.

Preferred: Accredited Case Manager (ACM)

Physical Demands:

Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending. Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.



Compensation

Base Salary - USD $180,000 to $230,000

Full-time

Benefits - Full

Relocation Assistance Available - Possible for ideal candidate

Commission Compensation - No

Bonus Eligible - No

Overtime Eligible - No

Interview Travel Reimbursed No

Candidate Details

5+ to 7 years experience

Seniority Level - Director

Management Experience Required - No

Minimum Education - Bachelor's Degree

Willingness to Travel Occasionally

Security Clearance Required: No

Visa Candidate Considered: No