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Duties and ResponsibilitiesÂ
â€¢Â Â Â Â Â Â Oversight of the Facilityâ€™s Case Management team to ensure compliance with standards of practice and other regulatory requirements related to care management and utilization review.
â€¢Â Â Â Â Â Â 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
â€¢Â Â Â Â Â Â Display an ability to work effectively within the health system's decision making and organizational structures.
â€¢Â Â Â Â Â Â Work closely with providers as well as internal and external physician advisors for utilization review and management activities
â€¢Â Â Â Â Â Â Coordinate all UM Committee activities to ensure compliance with meeting frequency and documentation of activity and outcomes
â€¢Â Â Â Â Â Â Work collaboratively with Revenue Cycle teams and participates in task force meetings related to medical necessity audits and denials.
â€¢Â Â Â Â Â Â Participate in appeals processes and work collaboratively with vendors to ensure the effectiveness and timeliness of appeals
â€¢Â Â Â Â Â Â 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
â€¢Â Â Â Â Â Â Introduce evidenced based practices geared to improve case management and transitions
â€¢Â Â Â Â Â Â 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:
Applicants with the following licensure may be considered:Â Oklahoma RN
Â Â Â Â Â Â Â Â Â Â Â
B.Â Education:Â Â Â BSN preferred, Registered nurse is required. Certification in Case Management or Utilization Review is preferred
â€¢Â Â Â Â Â Demonstrated leadership and complex organizational management skills
â€¢Â Â Â Â Â Excellent management, problem solving, team building & organizational skills
â€¢Â Â Â Â Â Familiarity with Federal & State regulations related to case management discharge planning.
â€¢Â Â Â Â Â Knowledge of integrated discharge planning practices and resources available to patients
â€¢Â Â Â Â Â Demonstrated knowledge of RACs, MACs and the Medicare appeals process
â€¢Â Â Â Â Â Ability to work with Administration, Physicians, and staff in multiple settings
â€¢Â Â Â Â Â Ability to compile reports and interpret data
â€¢Â Â Â Â Â 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.