Director of Case Management – 30 miles from San Francisco, CA

Director of Case Management – Full-Time

Location: Northern California Region

Compensation: $180,000 to $230,000 per year

Job Summary:
The Director of Case Management is responsible for overseeing hospital utilization, transition management, and the operations of the Case Management Department to ensure effective use of resources, compliance with regulatory requirements, and timely patient throughput. This role involves leading the implementation of utilization management plans, ensuring compliance with CMS regulations, and collaborating with the post-acute provider network.

Key Responsibilities:

• Manage department operations to ensure effective patient care and reimbursement processes.
• Lead hospital utilization management efforts and drive performance improvement.
• Ensure compliance with federal, state, and TJC accreditation standards.
• Develop physician education programs to improve utilization practices.
• Monitor and implement strategies to prevent payer disputes.
• Support effective patient transitions and discharge planning.

Qualifications:

• Education: Bachelor's in Business, Nursing, or Health Care Administration (RN) or Master's in Social Work (MSW). MSN, MBA, MSW, or MHA preferred.
• Experience: Minimum 3 years in acute hospital case management or healthcare leadership; 5 years preferred.
• Licenses: Active RN or LCSW/LMSW license required. ACM certification preferred.

Physical Demands:

• Ability to lift/push up to 25 lbs., frequent sitting, moderate walking, standing, and bending.

Benefits: Comprehensive benefits package, relocation assistance for ideal candidates.