Likeremote

Subscribe to the latest remote jobs:

  • Likeremote jobs on https://LinkedIn.com/
  • Likeremote jobs on https://telegram.org/
  • Likeremote jobs on Reddit.com
MD

Director of Case Management

Macpower Digital Assets Edge Private Limited
🇺🇸 United States
On-site
Manager or above
5 days ago
$120,000 – $193,000 / year
  • Regulatory Compliance
  • CMS
  • LCSW
  • LMSW
5 days ago
Auto apply with Likeremote
Not scoredNo CV on file. Upload one and this job gets a score out of 100.Upload CV
Position Summary:The Case Management Department Leader provides comprehensive operational oversight for hospital utilization management, transition management, and department workflows. This role ensures the efficient allocation of hospital resources, supports accurate revenue cycle processes, drives denial prevention, and promotes safe, timely patient throughput while maintaining strict compliance with state, federal, TJC, and organizational standards.
Core Scope of Services:
  • Utilization Management: Evaluates medical necessity and actively drives denial prevention strategies.
  • Transition Management: Optimizes length of stay, prevents readmissions, and enhances patient satisfaction.
  • Care Coordination: Ensures throughput efficiency, correct care sequencing, and appropriate care levels.
  • Regulatory Compliance: Adheres to state and federal mandates, TJC accreditation standards, and organizational policies.
  • Stakeholder Education: Provides guidance to physicians, patients, families, and caregivers.
Key Responsibilities:
  • Operations & Reimbursement: Direct department operations to secure effective patient throughput and optimize service reimbursement.
  • Utilization Performance: Lead the implementation and oversight of the hospital Utilization Management Plan, leveraging data analytics to drive continuous performance improvement.
  • Revenue Cycle Integrity: Ensure medical necessity and revenue cycle workflows are executed with precision, fully complying with CMS regulations and internal policies.
  • Transition & Throughput: Facilitate timely, effective patient transitions and discharge planning to support seamless hospital throughput.
  • Physician Engagement: Develop and deliver targeted education and performance feedback regarding hospital utilization practices.
  • Additional Duties: Perform other related duties as assigned.
Required Qualifications:
  • Education: Bachelor's degree in Business, Nursing, or Health Care Administration (for RN candidates); or a Master's degree in Social Work (for MSW candidates).
  • Experience: Minimum of 3 years of acute hospital case management or healthcare leadership experience.
  • Licensure & Certification: Active Registered Nurse (RN) or LCSW/LMSW license, maintaining current certification or registration to practice as required by state law and organizational policy.
Preferred Qualifications:
  • Education: Advanced degree, including MSN, MBA, MSW, or MHA.
  • Experience: 5 years of acute hospital case management leadership experience within multi-site operations.
  • Licensure & Certification: Accredited Case Manager (ACM) credential.

Director of Case Management · Macpower Digital Assets Edge Private Limited

Auto apply with Likeremote