Welfare Benefits Advisor PROSPECTUS

Director (RN) Case Management

Location: Houston, TX 77004

Job Type: Perm Full Time

Shift: Days; 9 am -5pm

Salary Range: Min $55 Max $60 an hour

Bonus Structure: 15% annually 4 performance bonus. If they perform extremely well there’s an upside so it could be higher (HR will go over the bonus structure with candidate)

Relo: case by case

What you will do in this role:

The individual in this position has 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.

This position integrates national standards for case management scope of services including:

• Utilization Management supporting medical necessity and denial prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and HCA policy
• Education provided to physicians, patients, families and caregivers

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 review processes are completed accurately and in compliance with CMS regulations and HCA 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) ensure compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.

Qualifications

What qualification you will need:

• Registered Nurse license
• BSN Required
• MSN preferred. Accredited Case Manager (ACM) preferred.
• At least two years of RECENT (WITHIN THE LAST YEAR) acute hospital case management leadership experience.
• Five years acute hospital case management experience preferred.