Group Director of Case Management

Title: Group Director of Case Management
Location: Modesto, CA
Job Type: Full Time/Permanent
Overview
The Group Director of Case Management is responsible for executing an organizational case management strategic plan across multiple healthcare facilities. This individual will serve as a leader, mentor, consultant, and subject matter expert on case management regulations and standards. The role involves overseeing hospital utilization management, transition management, and the operational management of the Case Management Department to ensure effective utilization of hospital resources, timely revenue cycle processes, denial prevention, and compliance with regulations related to case management services.

Key Responsibilities

• Lead and facilitate hospital directors in case management performance, including Level of Care, Length of Stay, and Payer Authorizations.
• Establish goals and objectives supporting the overall case management strategy.
• Oversee case management operations to ensure cost-effective and clinically sound care delivery.
• Assist in selecting and onboarding new hospital directors of case management.
• Make objective decisions based on facts and data, anticipating and addressing potential issues.
• Communicate effectively with all levels of the organization and external stakeholders.
• Provide leadership, support, and coaching to direct reports, helping them develop expertise and minimize staff turnover.
• Implement and monitor compliance with case management policies and regulatory requirements.
• Review key performance metrics such as length of stay, authorizations, and downgrades to monitor progress.
• Oversee hospital utilization management to drive improvements in performance using data.
• Ensure effective patient transition and planning to support efficient throughput.
• Prevent payer disputes and ensure compliance with regulations and accreditation standards.
• Provide physician education and feedback on hospital utilization and coordinate with the post-acute provider network.

Qualifications
Education:

• Required: Bachelor's degree in Business, Nursing, Healthcare Administration, or Master's in Social Work (MSW).
• Preferred: Advanced degree in business, nursing, healthcare administration, or related discipline.

Experience:

• Required: Five (5) years of acute hospital case management or healthcare leadership experience.
• Preferred: Experience in multi-site hospital case management leadership and business planning/project management.

License/Certificates/Credentials:

• Required: Registered Nurse (RN) or LCSW/LMSW license, as required by state regulations.
• Preferred: Accredited Case Manager (ACM).

Skills:

• Strong organizational skills, effective verbal and written communication, and leadership abilities.
• Critical thinking and problem-solving skills.
• Proficiency in using computer systems and software.
• Business planning experience is preferred.