Director of Case Management

CS&S STAFFING SOLUTIONS; Houston (TX); On-site; USD 120,000 - 180,000; Full time

Job summary

A healthcare staffing agency is seeking a Director of Case Management in Houston, Texas. The role involves managing the Case Management Department, ensuring hospital utilization performance and compliance with regulations. Candidates should possess an active RN license with at least two years of acute hospital case management experience, and prefer an MSN or ACM certification. Strong organizational and communication skills are crucial, along with critical thinking capabilities. This position offers an opportunity to lead a vital department in a fast-paced environment.

Qualifications

• Active Registered Nurse license with at least two years of acute hospital case management experience.
• MSN preferred.
• Accredited Case Manager (ACM) preferred.
• Five years of acute hospital case management experience preferred.
• Demonstrated organizational, verbal and written communication skills.
• Ability to lead and coordinate a diverse, fast-paced team.
• Strong critical thinking, problem solving and computer literacy.

Responsibilities

• Manage department operations for effective throughput and reimbursement.
• Lead implementation of the Utilization Management Plan.
• Ensure medical necessity review processes compliance.
• Ensure timely patient transition and planning.
• Implement processes to prevent payer disputes.
• Provide physician education on hospital utilization.
• ensure compliance with state and federal regulations and TJC accreditation standards
• other duties as assigned

Skills

Organizational skills

Verbal communication skills

Written communication skills

Critical thinking

Problem solving

Computer literacy

Critical thinking

Problem solving

Computer literacy

Business planning

Education

Active Registered Nurse license

MSN preferred

Accredited Case Manager (ACM) preferred

Five years acute hospital case management experience preferred

Tools

McKesson InterQual

Job description

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Job Description

POSITION TITLE: Director of Case Management

POSITION LOCATION: Houston, Texas

POSITION SUMMARY:

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.

The individual's responsibilities include the following activities:

• manage department operations to assure effective throughput and reimbursement for services provided
• lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
• ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and hospital policy
• ensure timely and effective patient transition and planning to support efficient patient throughput
• implement and monitor processes to prevent payer disputes
• develop and provide physician education and feedback on hospital utilization
• ensure compliance with state and federal regulations and TJC accreditation standards
• other duties as assigned

POSITION REQUIREMENTS:

Required qualifications include an active Registered nurse license with at least two years acute hospital case management experience. MSN preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual experience preferred. Five years acute hospital case management experience preferred. Required skills include 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 and computer literacy. Business planning experience preferred.

Additional Information

All your information will be kept confidential according to EEO guidelines.