Regional Claims Manager jobs in Huntsville, AL

Description

Case Manager

Job Summary:
Under the direction of the Director of Case Management, the Case Manager is responsible for the activities of utilization management, and care coordination in the development and implementation of a discharge plan for an assigned group of patients. The Case Manager serves as a resource for other members of the healthcare team and provides education to team members on issues related to the continuum of care, reimbursement, regulatory agency guidelines and resource use. Through collaborative teamwork, the Case Manager assures that the treatment plan is implemented accurately, in a cost effective and efficient manner in order to promote customer satisfaction and prevent delays in care and discharge. Responsible for reviewing medical necessity indicators to assure that appropriateness of care criteria is met. Document reviews and discharge planning in the medical record and/or the computer system as appropriate. Actively participates and comes prepared contribute to multidisciplinary rounds. Documents avoidable days to support process improvement activities and support other quality improvement programs / projects as needed. Reviews reasons for readmissions, concurrently appeal manage care denials. Collects and maintains data for tracking and reporting for outcome studies and performance improvement.

Qualifications

Qualifications:
· Current, valid, unrestricted AL RN license required. BSN preferred. Case Management certification preferred.
· Five (5) years clinical experience required.
· Basic computer skills (including Microsoft Word, Excel, Access and Office), fax copier and other office equipment experience required.
· Effective communication skills (verbal and written), time management and critical thinking skills required.
· Working knowledge of healthcare reimbursement, counseling, community resources, continuum of care and team building preferred.