RN Director of Case Management
San Francisco Bay Area, California
Base Salary up to $120K
Great opportunity for an experienced Director Case Manager for a growing Bay Area healthcare facility. You will float between Bay Area facilities to ensure Case Management goals and protocols are meet.
You will be responsible for case management, utilization review, discharge planning, and social services, as well as annual plans and budgets. Handle the financial resources of the patient and family, by coordinating the delivery of quality service. Manage relationships with the payers, physicians, hospital referral sources, and your case management staff. Help facilitate the discharge-planning process, and serve as an advocate for the patient and family. Work to ensure financial reimbursement of every individual case. You will still have case loads and participate in IDT's.
You will develop and implement the philosophies, policies, procedures and goals for the Case Management Department. Train and develop the Case Management staff and motivate them to accomplish department goals and objectives. Develop and oversee the annual Case Management budget. Prepare and evaluate monthly, quarterly and annual reports of the Department's functions. Provide information regarding changes in Medicare regulations and documentation issues to physicians and others as needed. Maintain Prospective Payment System, monthly case log and other files needed for peer review organization and specific needs of the hospital. Analyze physician utilization patterns, comparing to national and individual hospital standards. Communicate findings to Utilization Review and other appropriate individuals. Discuss denial of coverage related to Utilization Review with the Director of Quality Management. Assist with on-site monitoring reviews by PRO, Blue Cross, outside review organizations and third-party payers. Maintain a working relationship with local, state and federal agencies, recognizing the hospital's position in the community and its need for cooperation and assistance from such services.
The ideal candidate will have a BSN or higher, current active California RN license, Certification in Case Management, CCMC and ARN highly preferred! At least three (3) years of experience in Hospital Case Management. Should have in depth knowledge in TQM/QI and have recent experience as a Case Manager in insurance, workers compensation or medical management.
Call or email us today for full details! 713-861-8670 x111
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