PostJobMatches By WorkStaff USA
PostJobMatches By WorkStaff USA is a leading staffing agency in the job placement industry, providing top-notch professionals to facilities across the country. Our team of experienced recruiters work together to match the best candidates with the right job opportunities.
Today we are seeking a RN, Director of Care Management for our client in Geneva, NY. This position is in the Industry for Healthcare & Health Services. The job category is in Medical Health and Nurse Leadership.
The job details are as follows for this role:
Education Requirements
Masters in Nursing
Licensure
Required: Current New York State Registered Professional Nurse licensure.
The job Experience
Five years of Care Management hands on Leadership experience in a Hospital setting. Three (3) 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. Up to date clinical skills. The ideal candidate will be a Servant Leader.
Reports to
Chief Medical Officer
Supervises
Care Manager, RN UR, Secretary, Social Worker LMSW
Responsibility Summary:
1. Supervises professional and clerical employees who work with a range of functions, including but not limited to: access, pre-authorization and pre-certification, 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 hospital and 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.
Masters in Nursing
Current New York Stat Registered Professional Nurse Licensure
Five (5) Years Hands On Care Management Leadership Experience in a Hospital Setting
Have you worked in a Leadership Care Management Role in a Hospital Setting for at least 5 years?
Do you have a Masters in Nursing?
We are looking for a Servant Leader. Someone, who can jump on and work along side staff, while simultaneously leading the team.