Director Case Management (RN)
Company: Resiliency LLC
Location: Birmingham
Posted on: May 28, 2023
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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
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