Case Management Director
Case Management Director
Veracity Software Inc
Memphis, TN
See who Veracity Software Inc has hired for this role
Memphis, Tennessee
The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services.
This position integrates national standards for case management scope of services including:
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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet 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) participate in management of post-acute provider network, h) ensure compliance with state and federal regulations and TJC accreditation standards, and i) other duties as assigned.
Skills And Certifications
Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work
MSN, MBA, MSW or MHA.
3 years of acute hospital case management or healthcare leadership experience.
5 years of acute hospital case management leadership multi-site experience.
Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practical
Accredited Case Manager (ACM)
The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and 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 Tenet 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 and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet 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) participate in management of post-acute provider network, h) ensure compliance with state and federal regulations and TJC accreditation standards, and i) other duties as assigned.
Skills And Certifications
Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work
MSN, MBA, MSW or MHA.
3 years of acute hospital case management or healthcare leadership experience.
5 years of acute hospital case management leadership multi-site experience.
Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practical
Accredited Case Manager (ACM)
-
Seniority level
Entry level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Information Technology & Services
Referrals increase your chances of interviewing at Veracity Software Inc by 2x
See who you knowGet notified about new Director of Case Management jobs in Memphis, TN.
Sign in to create job alertSimilar jobs
People also viewed
-
Hospice Director of Clinical Services
Hospice Director of Clinical Services
-
Director of Nursing (Must be licensed or willing to license in TN)
Director of Nursing (Must be licensed or willing to license in TN)
-
Director-Nursing - DC Nursing Admin BMH Desoto
Director-Nursing - DC Nursing Admin BMH Desoto
-
Director of Nursing Service Line/ Oncology
Director of Nursing Service Line/ Oncology
-
Case Mgr/RN
Case Mgr/RN
-
RN Case Manager - Germantown Case Management - Full Time Days Monday-Friday
RN Case Manager - Germantown Case Management - Full Time Days Monday-Friday
-
RN-Case Manager - WH Case Management Admin BMH Women's
RN-Case Manager - WH Case Management Admin BMH Women's
-
RN-Case Manager - WH Case Management Admin BMH Women's at Baptist Memorial
RN-Case Manager - WH Case Management Admin BMH Women's at Baptist Memorial
-
Director of Nursing Services Exempt at Diversicare Healthcare Services & Diversicare Ther
Director of Nursing Services Exempt at Diversicare Healthcare Services & Diversicare Ther
-
RN Case Manager - South Case Management - Full Time Days
RN Case Manager - South Case Management - Full Time Days
Similar Searches
Explore collaborative articles
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
Explore More