Company Info

ADVANCED Professionals Inc.

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Executive Search Division, FL, United States

Phone: 800-595-3823 x211
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Company Profile

Director of Case Management



Case Management Director-VP


Attleboro, MA, United States 

Zip Code:


Employment Type:

Full time

# of Beds:


Job Requirements:

Educational Requirements: BSN with current MA license; Masters degree in Nursing, Health Care Administration, Business Management or related health care field preferred. Training: Minimum of 5-7 years management experience leading a Case Management department, including but not limited to: Utilization and Quality Management, Discharge Planning, Integrated Clinical Service/Care Coordination, and Risk Management.

Job Description:

Provides administrative leadership to the Department of Case Management with responsibility for Utilization Management, Integrated Clinical Service and Discharge Planning in accordance with Federal/State legal and regulatory requirements. The Director is accountable for maximizing access to and efficient utilization of resources in an integrated multidisciplinary patient care management program. The Director must ensure effective, timely communication with key stakeholders across the care continuum including patients, families, payers, and other healthcare facilities. Must effectively utilize established medical necessity criteria for admissions and transitions of care, length of stay and readmissions, with specific focus on high risk populations. Must possess in depth knowledge of Medicare (RAC), Medicaid and commercial claims review and denial processes, with administrative accountability for appeals preparation and submission.

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