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Group Director of Case Management

Level II Trauma Center

Modesto, CA

Virtus Healthcare Staffing is seeking a dedicated Group Director of Case Management to join our partner, a hospital in Modesto, CA.

Lead Case Management Excellence Across a Leading Level II Trauma Center

As the Group Director of Case Management, you will lead and facilitate performance across hospital Directors of Case Management, focusing on Level of Care, Length of Stay, and Payer Authorizations.

About the Hospital:

• 447 staffed beds.
• Offers a wide range of services, including emergency services, cardiac care, neurosciences, oncology, orthopedics, and women's health.
• Certified Comprehensive Stroke Center.
• STEMI Center.
• ECMO Capabilities.
• Level 3 NICU.
• 15 OR rooms.

Position Summary:

This position integrates national standards for case management scope of services. The Group Director of Case Management will lead and facilitate performance across hospital Directors of Case Management, focusing on Level of Care, Length of Stay, and Payer Authorizations. This role establishes goals and objectives aligned with the overall strategic plans for Case Management and Utilization Review.

Essential Responsibilities:

• Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery.
• Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes.
• Maintain objectivity in decision-making, utilizing data to support decisions.
• Anticipate and respond to problems and risks.
• Communicate effectively with all levels of the organization and with internal/external customers.
• Direct, support, and coach direct reports.
• Develop "experts " and "expertise " throughout the department and seek employee input.
• Minimize staff turnover.
• Lead implementation and monitoring of Case Management policy and regulatory requirements.
• Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics.
• Lead the implementation and oversight of the hospital Utilization Management Plan.
• Manage department operations to ensure effective throughput and reimbursement for services provided.
• Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with regulations and policy.
• Ensure timely and effective patient transition and planning to support efficient patient throughput.
• 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 accreditation standards.
• Perform other duties as assigned.

Qualifications:

• Education:
  • Required: Bachelor's degree in Business, Nursing, or Health Care Administration for RNs, or a Master's in Social Work for MSWs.
  • Preferred: Advanced degree in Business, Nursing, and/or Healthcare Administration, Health Science, or a related discipline.
• Experience:
  • Required: Five (5) years of acute hospital case management or healthcare leadership experience.
  • Preferred: Multi-site hospital case management leadership experience, business planning, and project management experience.
• License/Certificates/Credentials:
  • Required: Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW)/Licensed Master Social Worker (LMSW) license. Must be currently licensed, certified, or registered to practice the profession as required by law or regulation in the state of practice or policy. Active RN or LCSW/LMSW license for the state(s) covered.
  • Preferred: Accredited Case Manager (ACM)
• Required Skills:
  • Demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast-paced environment, critical thinking and problem-solving skills, and computer literacy. Business planning experience is preferred.

About Virtus Healthcare Staffing:

Virtus Healthcare Staffing is a leading healthcare recruitment firm dedicated to connecting talented professionals with exceptional opportunities.