Full-time (No weekends)
Reports directly to the Director of Case Management and provides oversight to the Case management team.
Responsible for coordinating, monitoring, executing and evaluating Case Management Department activities.
Accountable for assisting hospital utilization performance improvement 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.
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 HCA policy
Education provided to physicians, patients, families and caregivers.
Registered Nurse with active license; BSN required.
One year acute hospital case management leadership experience preferred.
McKesson InterQual® experience preferred.
Two years acute hospital case management experience preferred.
Accredited Case Manager (ACM) preferred.