The Director of Case Management (DCM) is responsible for the day to day operations and human resource management of the department of Case Management. With a central focus on census management, patient care outcomes, and key care indicators the DCM oversees the utilization management planning process to ensure the effectiveness and appropriateness. The Director of Case Management assumes responsibility for providing appropriate training, education and management of the department of Case Management. This position requires a person with strong leadership and negotiation skills, a working knowledge of regulations and contractual obligations and parameters of third-party reimbursement, Medicaid, and Medicare. The DCM oversees training and direction to support case managers skills sets.
Develops goals and objectives for area(s) of responsibility which are aligned with the strategic plan and/or organizational goals
Establishes key performance indicators utilizing industry or historical benchmarks; develops and implements a continuous quality improvement plan designed to improve performance
Develops, monitors, and coordinates all processes to assure RAC/OIG compliance
Establishes, implements and monitors revenue enhancement programs
Monitors commercial insurance denials, Medicare ADR and CERT; administers appeal requests
Drafts and maintains organization wide and departmental policies and procedures relevant to areas of responsibility
Bachelors Degree in Nursing required. RN license
3-5 years of management of a contemporary case management department.
Competitive salary and excellent benefits package.
HealthAdministrationNationwide.com - 30+ days ago
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