The Senior Regional Director of Case Management is responsible for implementing the strategy for Case Management as established by the National VP of Utilization Review and Management in collaboration with the Case Management Steering Committee.
The Senior Regional Director is an active participant of the Steering Committee, and is accountable for participating in the development of standard policies, procedures, work flows and data reporting for the PMH system and Southern California market. The Senior Regional Director is accountable for overseeing the execution of Corporate and Local policies and procedures, as well as meeting established performance metrics for Case Management Operations.
Required competencies include:
- Demonstrated knowledge of standard utilization screening tools such as MCG and InterQual.
- Experience and proficiency with Case Management software such as Midas, Cerner or Allscripts Care Manager.
- Knowledge of DRG, Value Based, Risk Based and Per Diem payment methodologies.
- Knowledge and application in State and Federal regulatory requirements pertaining to Case Management and Utilization Review processes.
- Ability to compile, interpret and develop action plans around data and analytics.
- This position requires an executive presence and professional communication skills as well as the ability to function in a matrixed environment.
- The ideal candidate is willing and able to oversee, mentor and develop CM leaders at the Director, Manager and Supervisor level, as well as work collaboratively with Hospital leadership at a facility operations level to address and improve identified issues.
Qualifications – Minimum
- Bachelor's Degree, Master's Degree strongly preferred.
- RN License required.
- Lean Six Sigma Certification or Case Management Certification preferred.
- Minimum of 3 years of experience in Case Management or Utilization Review at the Director Level required.
- Multi facility experience strongly preferred.
Job Type: Full-time