Director of Case Management

HCA Houston Healthcare Medical Center - Houston, TXDirector (RN) Case ManagementShift Details: Days; 9 am -5pmHCA Houston Healthcare Medical Center is a 444-bed acute care hospital in the heart of Houston's museum district. Established in 1975, the hospital has been serving Houston for more than 40 years. It provides a wide range of medical services, including cardiology, bariatrics, orthopedics, neurology, emergency care and more.The hospital is affiliated with HCA Houston Healthcare, part of the HCA Healthcare Gulf Coast Division. The division is a comprehensive network of hospitals, outpatient surgery centers, emergency centers and diagnostic imaging facilities in greater Houston, Corpus Christi and South Texas. Facilities include: 17 hospitals, nine ambulatory care centers, 13 off-campus emergency centers, and a regional transfer center.What you will do in this role:The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure compliance with all state and federal regulations related to case management services.This position integrates national standards for case management scope of services including:Utilization Management supporting medical necessity and denial preventionTransition Management promoting appropriate length of stay, readmission prevention and patient satisfactionCare Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of careCompliance with state and federal regulatory requirements, TJC accreditation standards and HCA policyEducation provided to physicians, patients, families and caregiversThe individual's responsibilities include the following activities: a) manage department operations to assure effective throughput and reimbursement for services provided, b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and HCA policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) develop and provide physician education and feedback on hospital utilization, , g) ensure compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.QualificationsWhat qualification you will need:Registered Nurse licenseBSN RequiredMSN preferred. Accredited Case Manager (ACM) preferred.At least two years of RECENT (WITHIN THE LAST YEAR) acute hospital case management leadership experience.Five years acute hospital case management experience preferred.Additional Notes: