Full job description
Position Summary
Serves as the central resource for the Executive Team concerning strategies which are efficient, effective, timely, patient-centered, and support appropriate financial reimbursement. Assumes 24-hour accountability for planning and direction of departments that provide: Access, Utilization Review, Denials and Appeals, Care Coordination, Discharge Planning, Clinical Social Work, Recovery and Disease Management, and Contracting. Collaborates with all disciplines, departments, payers, system partners, vendors, and community agencies to optimize clinical outcomes within best practice, ethical, legal, and regulatory parameters.
Essential Functions and Responsibilities Includes the Following:
Education & Experience Requirements
IF RN: RN with BSN or MSN required or BSN and a Master’s degree in clinical of health care administration, CMAC (Certified as a Case Management Administrator) or CCM (Certified Case Manager) certification preferred
IF SW: Master’s degree in social work, Licensed Social Worker (LMSW or LCSW), CMAC (Certified as a Case Management Administrator) or CCM (Certified Case Manager) certification preferred
Minimum Knowledge and Education :
1. Computer skills
2. Critical thinking
3. DRGs, Medicare Regulations, Medical Necessity Criteria
4. Patient Bill of Rights, HIPAA
Minimum Work Experience :
1. 1-year acute hospital experience, AND
2. 1 year experience in non-hospital-based health care (home care, insurance, outpatient, etc.)
3. Previous experience managing staff or successful project implementation
Specific Knowledge, Skills, Abilities :
1. Human resource management
2. Program evaluation and outcomes management
3. Market assessment and strategic planning
4. Leadership for change/change management
5. Assessment of clinical systems
6. Identification of at-risk populations
7. Development of strategies to manage at-risk populations
8. Collaborative, energetic, proactive
9. Technical writing for reports, letters, proposals, etc.
Core Competencies
Demonstrates ability to establish two-way communication by clearly defining expectations, communicating utilizing a variety of methods, actively listening to ideas and concerns and responding in an appropriate manner.
Demonstrates ability to delegate responsibilities appropriately.
Demonstrates the ability to retain composure under stress.
Physical/Mental Demands/Requirements & Work Environment
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