Director,Case Management
Rock Hill, SC, Full Time
$100,000-$145,000
What You'll Do
Are you a seasoned healthcare professional looking for a leadership role? Join our team as the Director of Case Management at our prestigious Medical Centers in either Rock Hill, SC. In this role, you will plan, organize, implement, and direct care coordination activities, providing oversight to case management, which includes care coordination, utilization review, social services, and discharge planning. You will work closely with medical staff and Medical Center leadership to identify patient care trends and issues, developing care management programs and clinical pathways to ensure efficient use of medical resources and high-quality, cost-effective care.
Certifications
Registered Nurse (RN) or LCSW/LMSW license.
Must be currently licensed, certified, or registered to practice profession as required by law or regulation in the state of practice or policy.
Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Experience
5+ years of experience with utilization review, clinical pathways, case management, and disease management are required. Supervisory experience is preferred.
Required: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience.
Responsibilities
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 the hospital’s policy.
Implement and monitor processes to prevent payer disputes.
Develop and provide physician education and feedback on hospital utilization.
Participate in the management of the post-acute provider network.
Ensure compliance with state and federal regulations and TJC accreditation standards.
Other duties as assigned.
Together, We Will Achieve
Together, we can achieve great things for our clients! As a qualified candidate for this exciting role, you'll be part of a team dedicated to offering excellent professional services that empower clients to focus on what they love. Your role and the work you do every day are at the very heart of our mission. Our clients expect you to work hard and have fun while utilizing your extensive experience, project and people management skills, and exceptional communication abilities to further your career and make a meaningful impact in the healthcare industry.