RN / Registered Nurse / Massachusetts / Any / RN Director, Case Manage

Company: KA Recruiting, Inc.
Location: Wellesley
Posted on: January 15, 2021

Job Description:

Looking for a RN Director of Case Management in Eastern MA! Qualifications: Education: BS/BSN required, MSN, MBA or MHA preferred. Experience: Required: Two (2) years in Case Management Leadership.Preferred: Five (5) years acute hospital case management experience preferred. Business planning experience preferred. McKesson InterQual-- experience preferred. Certifications: Required: Registered Nurse license. Preferred Accredited Case Manager (ACM). Skills and Certifications: Hospital Case Management leadership experienceRegistered Nurse Job Responsibilities:

• Manage department operations to assure effective throughput and reimbursement for services provided
• Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
• Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
• Ensure timely and effective patient transition and planning to support efficient patient throughput
• Implement and monitor processes to prevent payer disputes
• Develop and provide physician education and feedback on hospital utilization
• Participate in management of post-acute provider network
• Ensure compliance with state and federal regulations and TJC accreditation standards, andi) other duties as assigned.

Keywords: KA Recruiting, Inc., Boston , RN / Registered Nurse / Massachusetts / Any / RN Director, Case Manage, Healthcare , Wellesley, Massachusetts