Job Description:
At our hospital, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients. Everyone contributes to these moments, whether providing care directly or supporting those who do.As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible. We also take care of one another, helping teammembers further develop their career pathways and maximize their potential.
Employer Description Who We Are We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
Wellbeing support, including employee assistance program (EAP)
Time away from work programs for paid time off, long- and short-term plan coverage
Savings and retirement including a 401(k) Plan with a 50% match up to 6% of pay, employee stock purchase plan, flexible spending accounts, retirement readiness tools, rollover support, and financial well-being counseling
Education support through tuition assistance, student loan assistance, certification support, and online educational program
Additional benefits life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and employee discount program
Registered nurses – Retirement medical benefit account (RMBA) – 2% of annual eligible income set aside in accordance with program guidelines
Benefits may vary by location and role
SUMMARY: The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and 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 hospital policy
Education provided to physicians, patients, families and caregivers
The individual's responsibilities include the following activities: 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 hospital 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.
QUALIFICATIONS: Education
Required: Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
Preferred: MSN, MBA, MSW or MHA.
Experience
Required: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience
Certification
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
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.
The hospital complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Responsibilities The individual'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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and hospital 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) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.
