Director, RN Case Management (22896951)

Location: Texas - South Texas
Duration: Full Time
Job ID: 22896951
Company: C.O. Clover Group, Inc
Contact: C.O. Clover Group, Inc    Call: 6823479429
Practice Type:   Hospital
Job Posted: 09/09/21

Director, RN Case Management - 22896951


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 throughout, 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


The individual’s responsibilities include the following activities:

  • Manage department operations to assure effective throughput and reimbursement for services provided
  • Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
  • Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
  • Ensure timely and effective patient transition and planning to support efficient patient throughput
  • Implement and monitor processes to prevent payer disputes
  • Develop and provide physician education and feedback on hospital utilization
  • Participate in management of post-acute provider network


Required: Bachelor’s Degree in Business, Nursing, Social Work or Health Care Administration or relevant experience as approved by VP of Case Management

Preferred: MSN, MBA, MSW or MHA preferred


Required:  Two (2) years in Case Management Leadership


Preferred: Five (5) years acute hospital case management experience preferred. Business planning experience preferred. McKesson InterQual® experience preferred.


Required: Registered Nurse or LCSW/LMSW license; or relevant experience as approved by VP of Case Management

Preferred: Accredited Case Manager (ACM)