Director of Case Management

Job Type: Full Time

Job Shift: Days

Holiday Rotation:

Department: Case Management

This position reports directly to the Regional Case Managment Director, Indirectly Reports to the Chief Financial Officer. The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction, care coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care, compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy education provided to physicians, patients, families and caregivers.

Position Qualifications

Minimum Education: MSN preferred. Accredited Case Manager (ACM) preferred.

Minimum Experience/Skills: Minimum two years acute hospital case management leadership experience required. McKesson InterQual® experience preferred. Five years acute hospital case management experience preferred. Required skills include 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 preferred. Must complete Tenet’s InterQual education course within 30 days of hire (and at least annually thereafter) and pass with a score of 85 or better. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire. Attendance at hospital orientation is required. Must work with regional Performance Management and Innovation (PMI) Case Management leader to complete PMI Director of Case Management orientation within 90 days of hire.

License/Certificates/Credentials: Current and valid: Registered Nurse license, CA driver's license and proof of automotive insurance.

Physical Demands: While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl. Lift/position up to 25 lbs. Push/pull up to 25 lbs of force.

Vision Requirements: Sufficient perceptive acuity (vision and hearing) to perform all the related duties of the position. Ability to adjust vision sufficiently to perform duties.

Working Conditions: Individual works in a fast paced clinical and office environment.

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Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Doctors Medical Center of Modesto hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.

At Doctors Medical Center of Modesto, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

Medical, dental, vision, and life insurance

401(k) retirement savings plan with employer match

Generous paid time off

Career development and continuing education opportunities

Health savings accounts, healthcare & dependent flexible spending accounts

Employee Assistance program, Employee discount program

Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note : Eligibility for benefits may vary by location and is determined by employment status