Company Info

ADVANCED Professionals Inc.

APPLY NOW or Call for Job Description & Salary Info:
Executive Search Division, FL, United States

Phone: 800-595-3823 x211
Web Site: www.advancedprofessionals.com

Company Profile


Director, Case Management


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Category:

Case Management Director-VP

Location:

Antioch, CA, United States 

Zip Code:

94509
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Employment Type:

Full time

# of Beds:

145
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Job Requirements:

MINIMUM POSITION REQUIREMENTS: Education: Bachelor’s degree in health-related field required or equivalent combination of education and health care management experience. California Registered Nursing license. Master’s degree in nursing, management or related field preferred. Knowledge & Experience: Minimum of five years experience in a clinical field, which demonstrates ability to recognize level of care in patient settings and make decisions for placement within the continuum of care. Progressive experience in management, with demonstrated ability of supervision of multi-skilled personnel. Broad clinical background in acute and ambulatory care with knowledge of payer mix and contracting. Experience managing exempt and non-exempt staff. Working knowledge of MIDAS utilization management software. Working knowledge of an electronic medical record system and technology, preferably EPIC. Working knowledge and experience with Appeals/Denials process Working knowledge of Inter-Qual criteria and Milliman Care Guidelines. Experience in utilization management and discharge planning. Experience in managing and advocating for high risk, unfunded population. Knowledge of federal and state public health programs. Knowledge of long term care and skilled nursing environments. Special Skills/Equipment: Excellent written and verbal communication skills including presentation and facilitation skills. Ability to interact effectively with key internal and external constituents using Ability to promote teamwork and effectively function in teams as a leader or participant. Demonstrated ability to design, plan and implement projects and/or programs, process improvement, quality processes and techniques. Good PC skills including word processing, PowerPoint, Excel spreadsheets and managed care software programs. Demonstrated knowledge in management, hospital operations, and human resources.

Job Description:

The Case Management Director directs the operations of Case Management & Social Services at the Medical Center. The Director is accountable for case management, utilization review, palliative care, chaplain and social services. Case management oversight includes all points of entry including ambulatory surgery, observation, admission, ED case management, and Authorizations and Referrals. This position works closely with the leadership team and Hospital's At Home team to align Case Management operations with facility and East Bay region goals and directives. The Case Management Director works with the Chief Financial Officer, Chief Nurse Executive, VP of Medical Affairs, Utilization Review Physician Advisor, and the Hospitalist/Emergency Department Medical Directors to monitor utilization trends and implement plans to improve utilization performance. This position is responsible to carry out the annual utilization management program in conjunction with the medical staff and department managers. This position works closely with the Quality Manager to support and provide leadership in quality initiatives. The incumbent monitors for quality, utilization, readmissions and cost effectiveness, and provides outcomes reports to the Utilization Review Committee and the PI/RM/Medical Records Committee for review. This position also works closely with the Business Office Director and S3 to manage the Appeals and Denials process and RAC audits. This position will have other facility management responsibilities assigned based on operational need as agreed upon by the facility Chief Executive Officer, VP Medical Affairs, Chief Nurse Executive, and Assistant Administrator.

Job ID:

28274