Director, Case Management

' The Director of Case Management will administer and oversee the Case Management and Social Services departments to procure, coordinate a seamless delivery of healthcare services and ensure compliance with local, state, federal and private agencies as related to Case Management and Utilization Management. The Director of Case Management understands the principles of reimbursement and procurement of services within reimbursement parameters and will gather aggregate data required to monitor performance of processes and outcomes as related to quality and utilization. The Director of Case Management will participate and oversee the appeal/denial process and will be responsible for intervention when necessary to ensure that the care provided is necessary and performed in a timely manner to avoid loss of revenue to the hospital and potential denial of payment by the provider. The Director of Case Management will serve as liaison between patient, insurance company, business office, physician, admitting and nursing departments and implement new program functions and requirements of The Joint Commission and other regulatory agencies.   Education/Training/Experience: Bachelor's Degree in nursing or related field required; Master's degree preferred; Minimum five (5) years management experience required; Understanding of Medicare, MediCal, and other Third Party Payer regulations; Proficiency in InterQual Criteria; Knowledge of current utilization/quality management principles, techniques and procedures; Knowledge of the conventions, rules and guidelines for multiple data classification systems (example MS-DRG, APR-DRG); Working knowledge of Federal, State and local regulatory requirements related to both coding and clinical documentation; Knowledge of coding and operational implications of ICD-10; Effective communication skills.   10687
Salary Range: NA
Minimum Qualification
5 - 7 years

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