Case Management Director

Conifer Health Solutions • Indio, CA

12d • Onsite

About The Position

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.

Requirements

• Active Registered Nurse License
• At least two (2) years acute hospital case management leadership experience
• 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.

Nice To Haves

• MSN
• Accredited Case Manger (ACM)
• McKesson InterQual® experience
• Five (5) years acute hospital case management experience

Responsibilities

• Maintains an adequate number and skill mix over seven days a week to serve the patient population and meet the goals of the department
• Implements and supports with business case staffing requests utilizing the Tenet Case Management staffing recommendations and hospital budgetary guidelines
• Holds regular departmental meetings with staff to provide updates and provides for ongoing education
• Completes initial and annual competency and evaluation review on all case management staff
• Follows the InterQual Inter-rater Reliability (IRR) Policy to determine initial and yearly competency for all employees performing InterQual reviews
• Develops action plan for case managers that fail to meet the IRR acceptable "match" rate to ensure improvement in the accurate application of InterQual criteria
• Ensures new case management staff complete department orientation including review of Tenet Case Management and Compliance policies and Allscripts training.
• Monitors case management processes and staff productivity to ensure medical necessity reviews are completed timely and accurately, payer communications are sent and authorizations or denials documented and followed up, and that transition planning assessments are completed timely.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager