Our client, a 150+ bed hospital located between Sherman, TX and New Boston, TX, has a need for an experienced RN Director of Case Management to join their team. The Director will oversee 12 FTEs.
Responsible for the coordination and direction of all utilization management activities to support and implement the goals of the utilization management program and plan. Maintains oversight responsibility for the review of all PMG/IPA members usage patterns for medical necessity and appropriateness of care against screening criteria and for infection control, quality and risk assessment documenting same in computerized database. Responsible for authorization of appropriate services for PMG/IPA members; inputs authorizations and utilizes utilization management component of computer system. Coordinates the discharge planning function in conjunction with the discharge planner/social worker, assist Quality Management Coordinator and Risk Manager with screening, investigation and problem solving as needed. Assists the medical director with all utilization activities as requested and directed. Prepares agenda and meeting packet the Utilization Management Committee and documents a summary of the meeting contents in committee minute format. Responsible for education on and implementation of clinical guidelines and protocols. Responsible for coordination and presentation of utilization management program for all HMO due diligence and routine utilization management audits. Directs CQI activities and performance improvement activities within the department.
- Current State of Texas Registered Nurse Licensure, preferred.
- Five or more years utilization management experience in the managed care environment.
- Ten or more years acute hospital, home health, hospice, inpatient mental facility experience required.
With a city population of 25,000 plus an additional 23,000 residents in the county, the population base serves as the hub for healthcare and retail for Northeast Texas and Southeast Oklahoma. Our community is graced with dozens of vintage homes and unique architecture which sets the stage for a thriving community and a contemporary lifestyle. An array of cultural events, historical, scenic and recreational sites and community activities along with a rich selection of youth events makes this a great place for young families to raise children and older citizens to spend their retirement years!
- In addition, you’ll find:
- Two 18-hole golf courses; one nine-hole course
- Lakes throughout Northeast Texas and Southeast Oklahoma for boating, fishing, camping recreation (including Pat Mayse Lake, Lake Fork, Lake Crook and Beaver’s Bend State Park in Southeast Oklahoma.)
- Regional junior college with recognized technology programs and health education opportunities
- Year-around adult and youth sports programs
- Four-year university only 38 miles away offering
$80k - $102k
Sign on Bonus and Relocation Assistance is available. Incentive Bonus up to 10% based on established goals.