Director of Care Management / RN Licensed
Company: Crescent City Recruitment Group
Location: Geneva
Posted on: January 27, 2023
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Job Description:
Director of Care Management / RN Licensed:
Direct Hire
Full-Time (Days)
Competitive Compensation, based on experience.
Excellent Benefit Package
Location: Geneva, NY (Finger Lakes Region)
(Ability to Travel the short drive from Geneva to Penn Yan)
Reports: Chief Medical Officer
Department: Care Management
Supervises: CARE MANAGER, RN UTILIZATION REV, SECRETARY, SOCIAL
WORKER MSW
Education: Master's in Social Work, Business or Nursing
required.
License: Current NYS RN license required
*Must have Acute Care Experience*
Experience: Minimum: Five years' experience in a healthcare
setting. Three years' experience in utilization management or
denial management. Knowledge and experience in developing
utilization management and revenue recovery strategies. Experience
dealing with authorizations and appeals process. Knowledge of
discharge planning and clinical case management strategies.
Knowledge and experience in project management and team dynamics.
Knowledge of and experience with basic research methods and
statistical analysis. Preferred: DRGs, Medicare Regulations,
Medical Necessity Criteria, Patient Bill of Rights, HIPAA.
Responsibilities: Supervises professional and clerical employees
who work with a range of functions, including but not limited to
access, pre-authorization and precertification, bed placement,
coding, utilization review and denial management, care coordination
collaborative treatment planning and core measures, discharge
planning, clinical social work, tracking of the post-acute period
and provision of disease management, and contracting internally and
externally. 2. Partners with the CMO for effective relationships
with physicians, services, specialties, etc. 3. Provides
consultation to the executive team, forming effective relationships
with all VPs and department leaders. 4. Participates in the
determination and definition of the Care Management Dashboard,
using data to better understand strengths and weaknesses of the
department, and to determine needs, decisions, and strategies. 5.
Establishes, implements, and evaluates a written strategic plan for
the department that takes into account internal and external
factors. 6. Establishes, manages, and constantly evaluates staffing
levels, assignments, skills, learning needs, and deployment of
staff. 7. Creates stable and reliable processes to anticipate and
address specific situations within the department and between the
department and other departments and agencies. 8. Establishes
effective communication systems and forums with third party payers,
the local PRO/QIO, Medical Records, and the managed care and
finance offices. 9. Develops structures and processes to facilitate
participation by physicians, physical therapists, social work, and
other health professionals in multidisciplinary care planning, care
delivery, and discharge planning. 10. Participates in continuous
quality improvement groups. 11. Negotiates, approves, and manages
the operational and capital budgets. 12. Writes and conducts annual
and interim performance appraisals for all staff in the
department.
Ability to facilitate project management, work effectively under
pressure, meet deadlines, manage multiple priorities and enhance
the spirit of teamwork through effective role modeling. Familiarity
with JCAHO requirements. Excellent leadership, interpersonal,
communication (written and oral), analytical, and organizational
skills. Demonstrated ability to deal effectively with the public in
a professional and courteous manner. Computer literacy required
with word processing, spreadsheets, power point.
About the area: Located in the beautiful, nature enthusiast Finger
Lakes Region of New York State. It boasts quality wine trails of
the Finger Lakes wine region, a rich history, natural beauty, and
four-season attractions. Short drive to many area colleges and
universities.
Keywords: Crescent City Recruitment Group, Syracuse , Director of Care Management / RN Licensed, Executive , Geneva, New York
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