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Director of Case Management
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- Provides administrative leadership to the Department of Case Management with responsibility for Utilization Review, Integrated Clinical Service, Discharge Planning and Care Transitions in accordance with Federal/State legal and regulatory requirements, as well as private payer guidelines.
- Chairs the quarterly Utilization Review Committee, collecting, analyzing and reporting data on key metrics; responsible for preparation of agenda, minutes and dissemination of reports.
- The Director must possess in-depth knowledge of Medicare (RAC), Medicaid and commercial claims review and denial processes, with administrative accountability for appeals preparation and submission.
- Minimum of 3-5 years of progressively responsible experience in a Case Management leadership role including but not limited to: Utilization Review/Denials Management, Discharge Planning, Integrated Clinical Service/Care Coordination, Patient Throughput/LOS Management with solid track record of collaborative relationships with physicians, colleagues, and key stakeholders.
- In depth knowledge of acute care Case Management to include medical necessity, utilization review, LOS management, readmission reduction, denials management and effective transitions of care impacting revenue cycle
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