Director of Case Management FT Days
Apply NowCompany: Switch4 LLC
Location: Rock Hill, SC 29732
Description:
Title: Director of Case Management FT Days
Location: Rock Hill, SC
Job Type: FTE/Permanent
Responsibilities
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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's 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) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.
Qualifications
Education:
Required: Bachelor's degree in business, Nursing or Health Care Administration for RN or master's in social work for MSW
Preferred: MSN, MBA, MSW, or MHA
Experience:
Required: 3 years of acute hospital case management or healthcare leadership experience
Preferred: 5 years of acute hospital case management leadership multi-site experience
Certifications:
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Location: Rock Hill, SC
Job Type: FTE/Permanent
Responsibilities
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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and the hospital's 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) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.
Qualifications
Education:
Required: Bachelor's degree in business, Nursing or Health Care Administration for RN or master's in social work for MSW
Preferred: MSN, MBA, MSW, or MHA
Experience:
Required: 3 years of acute hospital case management or healthcare leadership experience
Preferred: 5 years of acute hospital case management leadership multi-site experience
Certifications:
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)