Director of Case Management

Conifer Health Solutions • San Antonio, TX

2d

About The Position

The Director of Case Management is responsible for hospital utilization performance improvement and operational management of the Case Management Department. The goal is 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, patient, families and caregivers. Completes established competencies for the position within designated introductory period. Other related duties as assigned.

Requirements

• Bachelor’s Degree from an accredited school, college or university as a Registered Nurse
• 2 years in acute hospital case management, healthcare or leadership experiences
• Possession of current Texas State registration as a Registered Nurse

Nice To Haves

• Master’s Degree from an accredited college or university in Nursing or related field
• 5 years in acute hospital case management.
• McKesson InterQual® experience and Business Planning experience
• Accredited Case Management (ACM)

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.
• Other duties as assigned.

What This Job Offers

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