Director Case Management

Welcome to Abrazo Health Network, where making a real difference in people's lives is at the heart of everything we do. Beyond just medical treatments, we believe in the power of genuine relationships and heartfelt compassion. It's what sets us apart and makes us truly special.

When you join our team, you're not just stepping into a job – you're becoming part of a community that uplifts and supports each other every day. We know that healthcare requires a unique blend of talent and dedication, and we are fully committed to providing an environment that enriches and rewards your journey.

Picture yourself among the brightest healthcare professionals, all united by a common purpose: caring for our community with unwavering commitment. At Abrazo Health, you won't just find colleagues; you'll find awe-inspiring teammates who share your passion for making a meaningful impact.

If you're ready to go above and beyond, to embrace the energy and camaraderie that Abrazo Health offers, then join us on this incredible adventure. Together, we'll embrace a healthier world – one patient at a time. Let your career find its purpose here at Abrazo.

Director Case Management Position Summary

The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and 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

Job Responsibilities
The individual’s responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, g) participate in management of post-acute provider network, h) ensure compliance with state and federal regulations and TJC accreditation standards, and i) other duties as assigned.

THE DIRECTOR CASE MANAGEMENT CANDIDATE WILL POSSESS THE FOLLOWING EDUCATION, LICENSE/CERTIFICATIONS, AND EXPERIENCE.

EDUCATION
Required: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work.
Preferred: MSN, MBA, MSW or MHA.

EXPERIENCE
Required: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience.

LICENSURE/CERTIFICATIONS
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)

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