RN Hospital DIRECTOR, CASE MANAGEMENT - Lakewood, CA 1666 JD
Description:
The individual in this position has 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.
This position integrates 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
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
Compliance with state and federal regulatory requirements, TJC accreditation standards and our company policy
Education provided to physicians, patients, families and caregivers
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 our company 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.
Qualifications:
•Current CA RN license
•5 years acute care experience
•Two years acute hospital case management leadership
•McKesson InterQual experience
•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
•Computer literacy
MWW
5+ to 7 years experience
Management Experience Required - No
Minimum Education - Certification
Willingness to Travel - Occasionally
ADDITIONAL DETAILS
Location: Los Angeles
Industry: Healthcare / Health Services - Nursing / LPNs / LVNs
Job Category: Medical / Health - Nurse Leadership
Hours Per Week:
Visa Candidate Considered: No
Description:
The individual in this position has 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.
This position integrates 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
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
Compliance with state and federal regulatory requirements, TJC accreditation standards and our company policy
Education provided to physicians, patients, families and caregivers
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 our company 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.
Qualifications:
•Current CA RN license
•5 years acute care experience
•Two years acute hospital case management leadership
•McKesson InterQual experience
•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
•Computer literacy
MWW
5+ to 7 years experience
Management Experience Required - No
Minimum Education - Certification
Willingness to Travel - Occasionally
ADDITIONAL DETAILS
Location: Los Angeles
Industry: Healthcare / Health Services - Nursing / LPNs / LVNs
Job Category: Medical / Health - Nurse Leadership
Hours Per Week:
Visa Candidate Considered: No