Director of Case Management and Utilization Review

3 weeks ago


Attleboro, Massachusetts, United States Sturdy Memorial Full time
Job Summary

Sturdy Memorial Hospital seeks a highly skilled and experienced Director of Case Management and Utilization Review to lead our team in providing exceptional patient care and ensuring compliance with regulatory requirements.

Key Responsibilities
  • Provide administrative leadership to the Department of Case Management, overseeing Utilization Review, Integrated Clinical Service, Discharge Planning, and Care Transitions.
  • Ensure effective communication with key stakeholders across the care continuum, including patients, families, physicians, payers, and representatives of other healthcare entities.
  • Develop and implement strategies to maximize access to and efficient utilization of resources in an integrated multidisciplinary patient care management program.
  • Chair the quarterly Utilization Review Committee, collecting, analyzing, and reporting data on key metrics.
  • Prepare and disseminate reports, ensuring timely and effective communication with stakeholders.
  • Ensure compliance with Federal/State legal and regulatory requirements, as well as private payer guidelines.
  • Develop and manage operational, capital, and IT budgets to achieve annual financial goals.
  • Lead daily interdisciplinary patient rounds and LOS meetings to facilitate timely, appropriate, cost-effective patient transitions.
  • Represent the department at institutional meetings, activities, and to external agencies and organizations as assigned.
Requirements
  • Minimum of 3-5 years of progressively responsible experience in a Case Management leadership role.
  • BSN required, Master's degree preferred.
  • Current MA licensure.
  • Expert knowledge of acute care Case Management, including medical necessity, utilization review, LOS management, readmission reduction, denials management, and effective transitions of care impacting revenue cycle.
  • Excellent communication, customer service, and organizational skills.
  • Solid fiscal and analytical skills to develop and manage budgets.
  • Outstanding leadership skills, characterized by professional interpersonal dynamics, team building, staff mentoring, and education, and relationship building with partners across the care continuum.
Preferred Qualifications
  • Master's degree in Health Care Administration, Business Management, Nursing, or related healthcare field.
  • Ability to listen and receive feedback openly and effectively.
  • Strong team approach to ensure collaboration across the care continuum.
  • Ability to multi-task, prioritize, and manage workflow in a dynamic environment.
  • Remain current with best practices impacting clinical outcomes and reimbursement, making recommendations on new approaches to effective patient transitions of care.

Sturdy Memorial Hospital is an equal employment opportunity employer. We are committed to diversity and inclusion in the workplace.



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