Oversee the Facility’s Case Management team to ensure adherence to standards and regulatory requirements for care management and utilization review.
Foster effective collaboration between Case Management Departments, Medical Staff, and facility leaders to ensure a unified approach to care provision aligned with hospital goals.
Demonstrate proficiency in navigating the health system’s decision-making and organizational structures.
Collaborate with internal and external physician advisors for utilization review and management activities.
Manage all UM Committee activities, ensuring compliance with meeting frequency and proper documentation.
Collaborate with Revenue Cycle teams, participating in medical necessity audits and denial-related task force meetings.
Engage in appeals processes and collaborate with vendors to ensure the efficiency of appeals.
Analyze length of stay and readmissions data, working with Operations team members and Corporate Case Management Directors to meet goals.
Introduce evidence-based practices to enhance case management and transitions.
Conduct regular staff meetings to review Federal and State regulatory requirements, emerging trends, and provide general training.
Qualifications: A. Licensure/Certification/Registration:
[Client Location] RN license required.
Certification in Case Management or Utilization Review preferred.
BSN preferred; Registered nurse is required.
Demonstrated leadership and complex organizational management skills.
Excellent management, problem-solving, team-building, and organizational skills.
Familiarity with Federal & State regulations related to case management discharge planning.
Knowledge of integrated discharge planning practices and available patient resources.
Understanding of RACs, MACs, and the Medicare appeals process.
Ability to collaborate with Administration, Physicians, and staff in multiple settings.
Proficiency in compiling reports, interpreting data, and delivering presentations.
Ability to interpret and apply InterQual criteria.
Minimum of 5 years of experience in case management, discharge planning, and/or utilization review in an inpatient acute care setting. Strong clinical background is preferred.
Share why this opportunity aligns with your professional goals.
Describe your leadership style.
Recruiter review and potential screening or direct referral to the hiring manager.
On-Site Panel Interview.
Company Culture & Perks: [Client Name] values a consistently positive, cooperative, self-motivated, courteous, and professional attitude in every position. While roles may differ, teamwork is crucial, and employees are expected to collaborate and contribute as needed. Effective communication and the ability to relate to others are essential functions of every position, with an emphasis on constructive feedback responsiveness.
Note: Resumes will be kept strictly confidential until we discuss a specific opportunity and mutually agree to proceed. If your experience aligns with our client’s requirements, we will contact you promptly to explore potential opportunities.
US Citizen or Green Card Holder is required for our award-winning client.