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Director of Case Management and Utilization Management

SRC Texas Scottish Rite for Children
Full-time
On-site
Dallas, Texas, United States
IT

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.

Required Skills/Abilities:

  • 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