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 prevention
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers
Required qualifications include an active Registered Nurse license with at least two years acute hospital case management leadership experiencers, MSN, MHA, MBA preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual® experience preferred. Five years acute hospital case management experience preferred.
Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy. Business planning experience preferred.
At Valley Baptist Medical Center — Brownsville, we’ve been providing comprehensive care services for the greater Brownsville community since 1923. Our faith-based mission is the foundation for the growth and development of our hospital to better serve you and your loved ones.
Here you’ll find:
Dedicated mental health services, with psychiatrists on site every day
Diagnosis and treatment for sleep disorders
Specialty resources for women’s health concerns
And much more!