The Dir Hospital Care Management leads and directs case management services, workflow and resources. Implement utilization management program that incorporates intake, clinical review, medical necessity, and appeals including written policies and procedures that ensure regulatory compliance with State , Federal and other oversight entities.
Monitoring utilization review plan and appropriateness of hospital admissions and extended hospital stays, ensuring the effective and efficient use of hospital services in order to optimize reimbursement for the hospital.
- Implements and monitors the case management program.
- Develops and maintains an integrated clinical care management model that fosters appropriate levels of care and maximized reimbursement.
- Oversees and monitors compliance and regulatory activities.
- Plans, organizes and directs all activities related to staffing, including hiring, orienting, evaluating and continuing education initiatives.
- Oversees compliance activities related to CMS, Joint Commission and state requirements in the hospital setting, including the maintenance of hospital/network standardized policies and procedures.
- Develops and maintains standardized initiatives related to hospital case management, including LOS, OBS, multidisciplinary rounding, effective discharge planning and hospital social work activities (general and specialized).
- Contribute to Mission effectiveness by promoting the spirit embodied within the Mission Statement: Service to the Poor - support the cause of those who lack resources for a reasonable quality of life; Reverence - respect and compassion for the dignity and diversity of life; Integrity - inspiring trust through personal leadership; Wisdom - integrating excellence and stewardship; Creativity - courageous innovation; Dedication - affirming hope and joy in our ministry.
- Required Credential(s):
- One or more of the following:
- Licensed Registered Nurse credentialed from the Tennessee Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date.
- Two years of direct management (supervisory) experiencerequired. Two years of Care Management experiencepreferred.