Director-Case Management
Job Posting for Director-Case Management at Southwestern Medical Center
Description
Duties and Responsibilities
• Oversight of the Facility’s Case Management team to ensure compliance with standards of practice and other regulatory requirements related to care management and utilization review.
• Develop and foster effective collaboration between Case Management Departments, Medical Staff, corporate and facility leaders to ensure an integrated approach to providing care while fulfilling the hospital's goals and objectives.
• Display an ability to work effectively within the health system's decision making and organizational structures.
• Work closely with providers as well as internal and external physician advisors for utilization review and management activities
• Coordinate all UM Committee activities to ensure compliance with meeting frequency and documentation of activity and outcomes
• Work collaboratively with Revenue Cycle teams and participates in task force meetings related to medical necessity audits and denials.
• Participate in appeals processes and work collaboratively with vendors to ensure the effectiveness and timeliness of appeals
• Analyze length of stay and readmissions data and incorporate measures with Operations team members, Corporate Case Management Directors and other facility leaders to ensure goals are met
• Introduce evidenced based practices geared to improve case management and transitions
• Conduct regular staff meetings to review pertinent Federal and State regulatory requirements, emerging internal and external trends, and provide general training for staff
Qualifications
II. Position Requirements:
A. Licensure/Certification/Registration:
Applicants with the following licensure may be considered: Oklahoma RN
B. Education: BSN preferred, Registered nurse is required. Certification in Case Management or Utilization Review is preferred
Skills
| • Demonstrated leadership and complex organizational management skills • Excellent management, problem solving, team building & organizational skills • Familiarity with Federal & State regulations related to case management discharge planning. • Knowledge of integrated discharge planning practices and resources available to patients • Demonstrated knowledge of RACs, MACs and the Medicare appeals process • Ability to work with Administration, Physicians, and staff in multiple settings • Ability to compile reports and interpret data • Ability to prepare and administer presentations Ability to interpret and apply InterQual criteria |
Experience: A minimum of 5 years experience in case management, discharge planning, and/or utilization review in an inpatient acute care setting. Strong clinical background is preferred.
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Job openings at Southwestern Medical Center
Lawton, OK
Other
Lawton, OK
Full Time
Lawton, OK
Other
Lawton, OK
Full Time
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