RN Director of Case Management Position
3 weeks ago
Job Summary:
As a key member of the Med Career Solutions team, the RN Director of Case Management Position plays a vital role in ensuring the delivery of high-quality medical services and discharge planning for our patients. This position requires a strong background in case management, with a focus on promoting a cooperative and supportive relationship with patients, family, facility staff, physicians, funding representatives, and community agencies.
Key Responsibilities:
- Communicate proactively and cooperatively with Patient Access, Patient Account Services, and Central Verification Office personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR.
- Communicate known changes to patient payer information and other relevant financial characteristics of coverage to appropriate admissions and billing personnel.
- Proactively ensure that required clinical justification is provided to third-party payers to obtain recertification for continued hospitalization and treatment, and that transfer of this information, together with days approved and contact information is provided timely to the Patient Account Services and Central Verification Office via computerized insurance review documentation.
- Serve as a liaison between third-party payers, patient access, Patient Account Services, and Central Verification Office to ensure communication of all pertinent information regarding level of care, billing, and reimbursement.
- Work with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary, funding is unavailable.
- Proactively initiate an expedited appeals process with payers and communicate with denials management regarding anticipated or verified denials and cooperates with denials management to provide additional clinical information for appeals.
- Educate the patient and family on case manager role and process for contacting the case manager for questions.
Requirements:
- RN licensure in the state of TX or Compact State.
- Associate's degree or BSN completion within 3 years of hire date.
- Must have Case Management experience within the acute care setting min 2 years.
Benefits:
Med Career Solutions offers a comprehensive benefits package that supports the health, life, career, and retirement of our colleagues. The available plans and programs include:
- Comprehensive medical coverage covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
- Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance, and more.
- Free counseling services and resources for emotional, physical, and financial wellbeing.
- 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service).
- Employee Stock Purchase Plan with 10% off facility Healthcare stock.
- Family support through fertility and family building benefits with Progyny and adoption assistance.
- Referral services for child, elder, and pet care, home and auto repair, event planning, and more.
- Consumer discounts through Abenity.
- Retirement readiness, rollover assistance services, and preferred banking partnerships.
- Education assistance (tuition, student loan, certification support, dependent scholarships).
- Colleague recognition program.
- Time Away from Work Program (paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence).
- Employee Health Assistance Fund offers free employee-only coverage to full-time and part-time colleagues based on income.
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