We are interviewing immediately for a Director of Case Management. This leader is responsible for the operational management of the Case Management Department; including staffing, budgets and plans. Responsibilities will include, but not limited to the following activities:
· Complies with relevant policies including Case Management and Clinical Determination Policies
· Implements and revises the Utilization Management Plan and promoting cooperation with utilization review standards by the medical staff
· Maintains communication between the case management department and the physician advisor on a regular basis regarding utilization review and or/or quality issues
· Maintains communication between the case management department and the physicians as well as other members of the healthcare team
· Analysis of reports: LOS, avoidable days, disputes, InterQual and associated metrics
· Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assigned.
Requires current California Registered Nurse license, Healthcare Provider BLS, BSN Degree
3+ years experience as a Case Manager.