Innovative Excellence LLC
"Real Leaders are Ordinary People with Extraordinary Determination" (unknown)
INTERIM DIRECTOR OF CASE MANAGEMENT
LOCATION - NORTHEAST
Massachusetts RN required (but can be pursued upon hire).
Reporting directly to the Vice President of Clinical Operations, the Director of Case Management will provide clinical and administrative leadership to the Department of Case Management with responsibility for Utilization Review, Integrated Clinical Service and Discharge Planning. In this position you will effectively utilize established medical necessity criteria for admissions and transitions of care, length of stay and readmissions, with specific focus on high risk populations. Must possess in depth knowledge of Medicare(RAC), Medicaid and commercial claims review and denial processes, with administrative accountability for appeals preparation and submission.
The successful candidate will have demonstrated effective communication skills with the care team, patients, families, payers, on-site reviewers and other healthcare facilities. Strong team approach and outstanding leadership skills, ability to foster collaborative relationships, prior experience with fiscal and analytical skills to develop/manage budgets, analyze and present metrics, expert knowledge of InterQual (or other) admission/medical necessity and documentation criteria, current knowledge of Press Ganey and HCAHPS measures and performance tracking, proficiency with computer applications; including Excel and Word, spreadsheets and presentation software, demonstrated ability to effectively and professionally multi-task in a changing environment.
Must be a graduate of an accredited school of nursing, possess a BSN with current MA licensure; Master’s degree in Nursing, Health Care Administration, Business Management or related health care field strongly preferred.