We are searching for a Director of Case Management for a hospital located in Southwestern Oklahoma
**Ask about our Unlimited PTO for Directors & Red-Carpet Relocation Package
Minimum 5 years of experience in case management, discharge planning and/or utilization review in an acute care setting.
Minimum 3years of Director experience at an acute care facility
RN compact or Oklahoma state license
Certification in Case Management or Utilization Review
**Ask about our Unlimited PTO for Directors & Red Carpet Relocation Package
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
Applicants with the following licensure may be considered: Oklahoma RN
Certification in Case Management or Utilization Review is preferred
B. Education: BSN preferred, Registered nurse is required.
• 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.
PAID TIME OFF