RN / Registered Nurse / Massachusetts / Any / RN Director, Case Management Job

Found in: beBee S US - 1 week ago


Wellesley, United States Nurse Job Board Full time

Looking for a RN Director of Case Management in Eastern MA

Qualifications: Education: BS/BSN required, MSN, MBA or MHA preferred. Experience: 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. Certifications:
Required: Registered Nurse license. Preferred Accredited Case Manager (ACM).

Skills and Certifications:
Hospital Case Management leadership experience
Registered Nurse

Job Responsibilities:
  • 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
  • Ensure compliance with state and federal regulations and TJC accreditation standards, andi) other duties as assigned.



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