No more applications are being accepted for this job
Director of Care Management - Detroit, United States - The National Coalition of Healthcare Recruiters
Description
(Only QUALIFIED Healthcare Professionals accepted)Hospital/Clinic – Case Management - DIRECTOR CASE MANAGEMENT -Full-time
DAYS
Location:
Detroit, Michigan.
POSITION SPECIFIC RESPONSIBILITIES:
Department Operations
·
Maintains an adequate number and skill mix over seven days a week to serve the patient population and meet the goals of the department
·
Implements and supports with business case staffing requests utilizing the Case Management staffing recommendations and hospital budgetary guidelines
·
Holds regular departmental meetings with staff to provide updates and provides for ongoing education
·
Completes initial and annual competency and evaluation review on all case management staff
·
Follows the InterQual Inter-rater Reliability (IRR) Policy to determine initial and yearly competency for all employees performing InterQual reviews
·
Develops action plan for case managers that fail to meet the IRR acceptable "match" rate to ensure improvement in the accurate application of InterQual criteria
Utilization Management
Implements and monitors processes to ensure medical necessity review processes are in place for patients to be in the appropriate status and level of care per policy.
Implements and monitors utilization review process in place to communicate appropriate clinical data to payers to support admission, level of care, length of stay and authorization for post-acute services.
Advocates for the patient and hospital with payers to secure appropriate payment for services rendered
·
Implements and monitors physician "peer to peer" review process with payers to resolve denials or downgrades concurrently.
Transition Management
·
Implements and monitors process to ensure that a transition plan assessment is completed within 24 hours of patient admission to identify and document the anticipated transition plan for patients
·
Ensures case management staff use electronic referral request process for patient placements
·
Monitors to ensure that patient choice is documented
Minimum Qualifications
1.
Graduate from an accredited school of Nursing. Bachelor's degree in Nursing or other health-related field, or the equivalent combination of education and|or related experience.
Master's degree in Nursing, Business Administration or Hospital Administration preferred.
2.
Licensed to practice as a Registered Nurse in the State of Michigan;
3.
Three to five years of acute hospital case management leadership experience.
Five years acute hospital case management experience preferred. McKesson InterQual experience preferred. Business planning experience preferred.
Competitive Compensation based on experience.
Benefits Package
Relocation Assistance Available - Possible
Commission Compensation - No
Qualifications:
2 to 5 years experience.
Seniority Level - Director
Management Experience Required - No
Minimum Education - Bachelor's Degree
Willingness to Travel - Occasionally
#J-18808-Ljbffr