Allentown, Pennsylvania
West Covina, California
Michigan
Denver, Colorado
Tennessee
Watertown, Wisconsin
Posted: 15-Nov-23
Location: Lawton, Oklahoma
Salary: Open
Categories:
Internal Number: 489386
**Ask about our Unlimited PTO for Directors & Red Carpet Relocation Package
Duties and ResponsibilitiesÂ
•      Oversight of the Facility’s Case Management team to ensure compliance with standards of practice and other regulatory requirements related to care management and utilization review.
•      Develop and foster effective collaboration between Case Management Departments, Medical Staff, corporate and facility leaders to ensure an integrated approach to providing care while fulfilling the hospital's goals and objectives.Â
•      Display an ability to work effectively within the health system's decision making and organizational structures.
•      Work closely with providers as well as internal and external physician advisors for utilization review and management activities
•      Coordinate all UM Committee activities to ensure compliance with meeting frequency and documentation of activity and outcomes
•      Work collaboratively with Revenue Cycle teams and participates in task force meetings related to medical necessity audits and denials.
•      Participate in appeals processes and work collaboratively with vendors to ensure the effectiveness and timeliness of appeals
•      Analyze length of stay and readmissions data and incorporate measures with Operations team members, Corporate Case Management Directors and other facility leaders to ensure goals are met
•      Introduce evidenced based practices geared to improve case management and transitions
•      Conduct regular staff meetings to review pertinent Federal and State regulatory requirements, emerging internal and external trends, and provide general training for staff
II. Position Requirements:
A. Licensure/Certification/Registration:
Applicants with the following licensure may be considered:Â Oklahoma RN
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B. Education:    BSN preferred, Registered nurse is required. Certification in Case Management or Utilization Review is preferred
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Skills
•     Demonstrated leadership and complex organizational management skills •     Excellent management, problem solving, team building & organizational skills •     Familiarity with Federal & State regulations related to case management discharge planning. •     Knowledge of integrated discharge planning practices and resources available to patients •     Demonstrated knowledge of RACs, MACs and the Medicare appeals process •     Ability to work with Administration, Physicians, and staff in multiple settings •     Ability to compile reports and interpret data •     Ability to prepare and administer presentations Ability to interpret and apply InterQual criteria |
Experience:Â Â A minimum of 5 years experience in case management, discharge planning, and/or utilization review in an inpatient acute care setting. Strong clinical background is preferred.