Director Case Management (RN)

Company: Resiliency LLC
Location: Birmingham
Posted on: May 28, 2023

Job Description:

SummaryThe 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 throughput, 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 preventionTransition Management promoting appropriate length of stay, readmission prevention and patient satisfactionCare Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of careCompliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policyEducation provided to physicians, patients, families and caregiversResponsibilitiesThe individual's responsibilities include the following activities:Manage department operations to assure effective throughput and reimbursement for services providedLead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvementEnsure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policyEnsure timely and effective patient transition and planning to support efficient patient throughputImplement and monitor processes to prevent payer disputesDevelop and provide physician education and feedback on hospital utilizationParticipate in management of post-acute provider networkEnsure compliance with state and federal regulations and TJC accreditation standards, andi) other duties as assigned.EducationRequired: Preferred: BS/BSN preferred (BSN required if Magnet Hospital). MSN, MBA or MHA preferred.ExperienceRequired: 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.CertificationsRequired: Registered Nurse license. Preferred Accredited Case Manager (ACM).Security Clearance Required: NoVisa Candidate Considered: NoCOMPENSATIONBase Salary - USD $101,000 to $187,000*** Never repost ***Full-timeBenefits - FullRelocation Assistance Available - Possible for ideal candidateCommission Compensation - NoBonus Eligible - NoOvertime Eligible - NoInterview Travel Reimbursed - NoCANDIDATE DETAILS Seniority Level - DirectorManagement Experience Required - NoMinimum Education - Bachelor's DegreeWillingness to Travel - OccasionallyPDN-99273ffe-feb2-49d6-a15d-15ffbf94c5db

Keywords: Resiliency LLC, Birmingham , Director Case Management (RN), Healthcare , Birmingham, Alabama