Director of Case Management and Utilization Management Job at Scottish Rite for

Our patients are our number one priority! We're committed to giving children back their childhood!

Job Posting Title:
Director of Case Management and Utilization Management

Location:
Dallas - Hospital

Additional Posting Details:

Monday - Friday 8:00am to 4:30pm

Job Description:

Duties/Responsibilities:

• 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 the 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
• 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, Texas Medicaid and SRC 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,
• Ensure compliance with state and federal regulations and TJC accreditation standards,
• Other duties as assigned.

• Bachelor degree in Nursing or Health Care Administration for RN required
• MSN, MBA, or MHA preferred
• 3 years of acute hospital case management or healthcare leadership experience required.
• 5 years of acute hospital case management leadership including surgical and critical care patients preferred
• Registered Nurse. Must be currently licensed, certified or registered to practice profession as required by law or regulation in Texas required.
• Accredited Case Manager (ACM or other certification) preferred