Looking for a RN Director of Case Management in Eastern MA.
Qualifications:
Education: BS/BSN required, MSN, MBA or MHA preferred.
Experience: Required: Two (2) years in Case Management Leadership.
Preferred: Five (5) years acute hospital case management experience preferred. Business planning experience preferred. McKesson InterQual experience preferred.
Certifications: Required: Registered Nurse license. Preferred Accredited Case Manager (ACM).
Skills and Certifications: Hospital Case Management leadership experience
Registered Nurse
Job Responsibilities:
- Manage department operations to assure 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 Tenet 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, andi) other duties as assigned.