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Director of Case Management ($175,000 SALARY)
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Job Description

  • The Director of Case Management will oversee the Case Management and Social Services departments, the objective will be to coordinate a seamless delivery of healthcare services and ensure compliance with local, state, and federal rules and regulations. 

 

  • The Director of CM understands the principles of reimbursement and procurement of services within reimbursement parameters and will gather aggregate data required to monitor performance of processes and outcomes as related to quality and utilization. 

 

  • The Director of CM will participate and oversee the appeal/denial process and will be responsible for intervention when appropriate to ensure that the care provided is necessary and performed in a timely manner to avoid loss of revenue and potential denial of payment by the provider. 

 

  • The Director of CM will serve as a liaison between patients, insurance companies, physicians, and nursing departments.







Job Requirements


    • Bachelor’s Degree in nursing or related field. Master’s degree preferred
    • Current BLS Card
    • Minimum five years management experience
    • Strong background in Acute care settings
    • Understanding of Medicare, MediCal, and other Third Party Payer regulations 
    • Proficiency in InterQual Criteria
    • Knowledge of current utilization/quality management principles, techniques and procedures 
    • Knowledge of the conventions, rules and guidelines for multiple data classification systems (example MS-DRG, APR-DRG) 
    • Working knowledge of Federal, State and local regulatory requirements related to both coding and clinical documentation
    • Knowledge of coding and operational implications of ICD-10

Job Snapshot

Employment Type Full-Time
Job Type Nurse, Health Care, Executive
Education 4 Year Degree
Experience At least 5 year(s)
Manages Others Yes
Industry Healthcare - Health Services, Managed Care, Not for Profit - Charitable
Required Travel Not Specified
Job ID 10A*
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Director of Case Management ($175,000 SALARY)


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