Director of Case Management career at American Recruiters in Georgia

American Recruiters is employing Director of Case Management on Wed, 04 Dec 2013 18:38:38 GMT. QUALIFICATIONS: Required qualifications include an active Registered Nurse license with at least two years acute hospital case management leadership experience...

Director of Case Management

Location: Georgia Georgia

Description: American Recruiters is employing Director of Case Management right now, this career will be placed in Georgia. Detailed specification about this career opportunity kindly read the description below. Job Description

Director of Case Management/Utilization Review - 175-bed acute care hospital - Georgia - salary midrange is mid to high 90Â' s (will go higher for a very well qualified candidate) plus annual bonus potential up to 10% of base

The role is responsible for all components of case management and utilization review for our facility. We currently have 10 case managers and 3 discharge planners as well as a case management supervisor and a dept secretary. The position will report to our CFO. We would prefer someone with a for-profit background. Previous Case Management Director experience woul! d be strongly preferred but a solid assistant director/manager! would be considered if the Case Management background is extensive.

SUMMARY:
The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.

This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of! care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers

The individualÂ' s responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and health system policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization,, g) ensure compliance with state and federal regulations and TJC accredita! tion standards, and h) other duties as assigned.

Job Requireme! nts

QUALIFICATIONS:
Required qualifications include an active Registered Nurse license with at least two years acute hospital case management leadership experience. MSN preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual(R) experience preferred. Five years acute hospital case management experience preferred. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy. Business planning experience preferred.
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If you were eligible to this career, please email us your resume, with salary requirements and a resume to American Recruiters.

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This career starts available on: Wed, 04 Dec 2013 18:38:38 GMT

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