Case Management Supervisor

4 weeks ago


Addison, Texas, United States Surgery Partners Full time

Job Summary

The Case Management Supervisor will oversee the utilization review process, ensuring that patients receive the appropriate level of care in the correct setting. This role will also manage the discharge planning process, ensuring a smooth transition for patients moving to the next level of care.

Key Responsibilities

  • Supervise a small staff, assigning, reviewing, and evaluating their work.
  • Manage the utilization review process, reviewing authorizations for correct type of stay, managing the correct level of care in the correct setting, and managing and appealing claims that have been denied.
  • Manage the discharge planning process, ensuring patients move to the appropriate level of care after discharge.
  • Communicate medical and reimbursement policies and regulations to surgeons, clinicians, and non-clinicians in a timely manner.

Requirements
  • RN license required.
  • BSN required; CCM strongly preferred.
  • Minimum of 5 years of previous case management experience in a hospital setting.
  • Understands the importance of teamwork when achieving desired results.
  • Understands basic CMS guidelines and has experience working with payor specific medical policies and reimbursement methodologies.
  • Understands how to use InterQual or Milliman to determine the appropriate level of care.
  • Understands basic coding principles and chargemaster operations.
  • Ability to be assertive with persuasive communication skills; action oriented.
  • Ability to be organized and efficient with time.
  • Ability to be compassionate to people and their situations to work with them in a positive way that will help them make positive forward strides.
  • Critical thinking skills, decisive judgment, and the ability to work with minimal supervision while meeting firm deadlines.
  • Communication skills necessary to be a good listener and speak in an understandable way.
  • Previous supervisory experience preferred.

Work Environment
  • The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

Physical Demands
  • The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.


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