Qualifications:

Education:

BS/BSN required, MSN, MBA or MHA preferred. 

Experience:

Required: Two (2) years in Case Management Leadership.
Preferred: Five (5) years acute hospital case management experience preferred. Business planning experience preferred. McKesson InterQual® experience preferred. 

Certifications:
Required: Registered Nurse license. Preferred Accredited Case Manager (ACM).

Skills and Certifications:
Hospital Case Management leadership experience
Registered Nurse 

 

Job 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, andi) other duties as assigned.