Director of Care Management - RN Licensed
Company: USA Staffing Network
Posted on: January 27, 2023
(Only QUALIFIED Healthcare Professionals accepted) Other-Nurse
Manager/Executive - Director of Care Management - RN Licensed:
Competitive Compensation, based on experience.
Excellent Benefit Package
Location: Geneva, NY (Finger Lakes Region)
Reports: Chief Medical Officer
Department: Care Management
Supervises: CARE MANAGER, RN UTILIZATION REV, SECRETARY, SOCIAL
Education: Masters in Social Work, Business or Nursing
License: Current NYS RN license required.
Experience: Minimum: Five year experience in a healthcare setting.
Three year 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
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.
Keywords: USA Staffing Network, Syracuse , Director of Care Management - RN Licensed, Executive , Geneva, New York
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