The Director of Case Management will work with members of the corporate Clinical Operations team and Case Management staff at each IASIS owned facility to develop and ensure execution of policies/procedures. The IASIS case management function (included as an integral part of the Hospital Medical Management and Quality Program (HMMQP)) includes, but is not limited to, the execution of policies and standardized processes to improve the clinical determination of patient status and across the continuum of care, reduce ALOS/manage to GLOS, improve clinical documentation; maintain governmental compliance, and reduce denials/disputes arising from governmental and managed care payors. The Director of Case Management will work closely with Corporate, Region and Hospital management to achieve and sustain staffing targets for case management activities through the direct management and collaboration with content experts and sharing best practices.
This role requires travel approximately 80-90 percent of the time in working with both hospital and office environments. Due to the extensive travel of this position, other locations will be considered.
Qualifications and Requirements:
RN with Bachelor's degree is required. Master's degree in nursing or other healthcare related field highly desirable.
5 years of leadership and managerial responsibility in hospital case management. Multi-hospital responsibility in a healthcare system is highly preferred.
Demonstrated experience with providing education via classroom, webex, and other mediums.
Demonstrated experience with reducing length of stay and reducing third party payor payment denials and disputes.
Experience working in a case management consulting role would be a plus.
The successful candidate must possess diverse knowledge in clinical, financial and compliance areas, with the ability to incorporate this knowledge into operational performance improvements.
Solid knowledge base in federal regulations as they relate to utilization review; extensive comprehension of Medicare, Medicaid, and insurance guidelines.
Solid understanding of reimbursement methodologies; and working knowledge of InterQual and Milliman for medical necessity and appropriateness of care.
Strong analytical and problem solving skills are a must.
Advanced PC skills including Word, Excel, PowerPoint and Lotus Notes.
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