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Job description
Director of Case Management
Worcester, Massachusetts
Full Time
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 Tenet policy; and Education provided to physicians, patients, families, and caregivers 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 Tenet policy
Ensure timely and effective patient transition and planning to support efficient patient throughput
develop and provide physician education and feedback on hospital utilization
other duties as assigned.
Required: Education: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
Experience: 3 years of acute hospital case management or healthcare leadership experience
Licensure/Certification: 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: Experience: 5 years of acute hospital case management leadership multi-site experience
Education: MSN, MBA, MSW, or MHA
Licensure/Certification: Accredited Case Manager (ACM)
Worksite address
worcester, MA, 01609, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.