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Job Description

POSITION TITLE: Director of Case Management

POSITION LOCATION: Houston, Texas

POSITION SUMMARY: 

Overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.

The individual's responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, B)) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and hospital policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, g) ensure compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.

POSITION REQUIREMENTS:

Required qualifications include an active Registered nurse license with at least two years acute hospital case management experience. MSN preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual experience preferred. Five years acute hospital case management experience preferred. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy. Business planning experience preferred.

Additional Information

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