Responsibility:

1. Will execute on the strategic plan and will provide subject matter expertise for Case Management regulations and standards, including ensuring compliance with all state and federal regulations.
2. Will ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput.
3. Includes integration of national standards for Case Management scope of services, including utilization management supporting medical necessity and denial prevention, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
4. Further, includes care coordination by demonstrating throughput efficiency while assuring care is the right sequence and of the appropriate level.
5. Will serve as an information resource, and will work in collaboration with physicians, allied health professional administrators, corporate, finance department staff, supply chain staff, vendors, and individual internal and external to the Detroit Medical Center.

Required Qualification:

1. Bachelor’s degree in business, nursing or health care administration required. Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred.
2. A minimum of 5 years of experience in hospital revenue cycle function. Five (5) years in hospital Case Management Leadership required. Multi-site hospital case management leadership experience preferred. Business planning and project management experience preferred.
3. Registered Nurse or LCSW/LMSW license; or relevant experience as approved by VP of Case Management required. Accredited Case Manager (ACM) preferred.