Opportunity: Corporate Director of Case Management, Utilization Review & Social Work

The Centra Health System has retained DCCS to lead an executive search for a Corporate Director of Case Management, Utilization Review & Social Work.

Learn more about Centra Health: centrahealth.com/AboutCentra

Based in beautiful Lynchburg, VA, Centra Health currently consists of a 4-Hospital Regional Healthcare System including 8,100 employees, 500 employed providers and physicians, and a medical staff of nearly 800 providing care. Centra Health also includes Centra Specialty Hospital, a long-term acute care hospital, a regional standalone emergency department, health and rehabilitation centers, a cancer center, a nursing school, sites and providers serving a geography of approximately 9,000 square miles, and a health plan.

The Corporate Director of Case Management, Utilization Review & Social Work will facilitate the establishment of this new system-wide leadership role including assessment of structures, process, education and competencies of staff, and recommendations for development and retention systems for staff.

The Corporate Director of Case Management, Utilization Review & Social Work plans and directs clinical operational and financial operations to ensure quality and timely flow of patients from acute care through the continuum of care for the health system. Supervises Case Management and Social Work Departments for the health system.

• Builds diverse clinical and organizational teams to focus on efficiency patient needs and flow throughout the continuum of care utilizing team building skills.

• Builds relationships with those involved in the discharge process throughout the continuum of care.

• Coordinates education opportunities for the staff personnel & physicians regarding continuum of care reimbursement regulations and care issues.

• Creates and coordinates improvement in processes for transition to continuum of care providers.

• Demonstrates ability to make decisions balancing needs of the patient within confines of various internal and external factors.

• Demonstrates knowledge of federal and state Medicare/Medicaid and other regulations affecting reimbursement utilization and discharge planning.

• Demonstrates knowledge of insurance/government/contracts reimbursement methodologies.

• Demonstrates knowledge of Interqual and multiple criteria sets and able to apply to patient populations.

• Develops processes to improve efficiency and achieve smooth transitions to post-acute services.

• Facilitates increasing staff members knowledge of their job duties and assists the team as needed.

• Keeps up to date with regulations, third party payers, system processes, and continuum of care processes.

• Performs workflow analyses payer analyses audits and looks for ways to increase efficiencies.

Qualifications

• Current, active license as a registered nurse in Virginia or from a compact state

• Master's Degree or higher

• Case Management Leadership: 5 years

• Social Work Leadership: 5 years

• Utilization Management: 5 years

If you or someone you know may have an interest to learn more, please contact us at:

Steve Grace, Partner, DCCS Consulting:

sgrace@dccsconsulting.com | Mobile: 614-531-7012

Or

Debbie Linnes, COO and Partner, DCCS Consulting:

dlinnes@dccsconsulting.com | Mobile: 814-777-6179

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