Director of Case Management
1 week ago
Job Summary
The Director of Case Management will oversee the hospital's utilization management, transition management, and operational management of the Case Management Department. This role will 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.
Key Responsibilities
- Manage department operations to ensure 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 company 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
Requirements
- Two (2) years in Case Management Leadership
- Registered Nurse license
- Preferred: Accredited Case Manager (ACM) certification
Benefits
- Full-time position with excellent benefits package
- Relocation assistance available
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