Case Management Director (RN)

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Written by nashvillejobs

Description

SHIFT: No Weekends

SCHEDULE: Full-time

TriStar Skyline Medical Center is Tennessee’s first comprehensive stroke center and a national leader in neuroscience. The facility has 264 beds and offers medical and surgical programs, including heart and vascular, oncology, orthopedics/spine and CARF accredited rehabilitation.

 

TriStar Skyline Medical Center’s Awards and Recognitions:

 

Trauma – Designated Level II Trauma Center

Cancer – Accredited Cancer Program Certified by the Commission on Cancer

Heart – Accredited Chest Pain Center

Stroke – First in the state to be named a Comprehensive Stroke Center

Quality – Top Performer on Key Quality Measures by The Joint Commission

The Joint Commission – Accredited by The Joint Commission

Inpatient Acute Rehabilitation –  Accredited by CARF. Only CARF accredited program in Middle TN

 

Position Responsibilities:


Leadership:

  • Review the Utilization Management Plan annually:  holds self and others accountable for successfully achieving approved plans; develops, monitors, and review action plans.
  • Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources.

Teamwork:

  • Provides feedback to Division Case Management Director on issues related to department operations:  offers input to Division Director on managed care contracting issues; best demonstrated practices; process improvement and utilization management activities; barriers to achieving goals and objectives of initiatives; participates in HCA Case Management and Division initiatives; including, but not limited to Medicare One Day Stay initiative.
  • Initiates and facilitates collaboration with hospital staff, PAS, managed care with a goal of contract compliance and decreasing payer denials or non-medically necessary days at the facility level.

Regulatory and Quality Improvement:

  • Implements and monitors regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives related to Case Management services; provides regulatory and compliance updates to staff, provides standards of practice updates, initiates / drives process changes to ensure compliance  to such regulations and quality initiatives as it relates to Case Management.
  • Collaborates with the Director of HIM in overseeing utilization management committee functions and effectiveness.

Analysis:

  • Performs data analysis related to Case Management metrics; develops, implements and monitors action plans related to denials, avoidable days, Medicare One Day Stays, Accretive (Physician Advisor), LOS, QIO data (PEPPER reports, et al), and other case management metrics identifying opportunities for improvement.
  • Identifies and implements resource reduction strategies consistent with facility strategic plan with a focus on quality outcomes, reduction of length of stay, medical necessity and level of care.

Training and Development:

  • Assesses learning needs of social worker and case managers: provides for on-going educational needs.

What we offer:

  • Industry Leading Clinical Training and Professional Academy – Emerging Leaders
  • Tuition Reimbursement and Student Loan Forgiveness Programs
  • Generous PTO Plan
  • 401k (3%-9% match based on tenure)
  • Employee Stock Purchase Plan
  • Full Medical, Dental, and Vision Insurance
  • Healthcare and Dependent Care Flexible Spending Accounts
  • Financial Fitness Program with a Certified Financial Planner
  • Any many, many more!

Qualifications

  • RN with current state licensure, BSN preferred.
  • Five years Nursing Case Management experience; 2 years Director or Supervisor experience preferred.
  • Certification in Case Management, Nursing, or Utilization Review, preferred.
  • Ability to establish and maintain collaborative and effective working relationships.
  • Demonstrates analytical and critical thinking abilities with pro-active decision-making, problem solving and negotiation skills.

Notice

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For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

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