Director, Case Management
AHS Vista LLC
- Waukegan, IL
- Permanent
- Full-time
- Ensures that the Case Management organization complies with all healthcare regulations, nursing regulations, Joint Commission, & co. policies & procedures.
- Identifies ideas, actions, & processes to improve quality, reduce risk, & maintain patient safety.
- Maintains knowledge of healthcare delivery models, healthcare economics, and healthcare policy.
- Acts as a liaison with the nursing/ medical staff, patient, families and community agencies to facilitate problem solving, post discharge care and coordination of services.
- Develop reporting tools that effectively measure and monitor processes throughout the denials management process in order to support process improvement.
- Ensures the department financial budget is achieved.
- Effectively utilizes database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for Case Management processes and systems.
- Must possess Bachelor's in Nursing (BSN) degree, Masters in Nursing, Health Care or Business Administration, preferred.
- Five to seven years' experience in Case Management, discharge planning, and/or utilization review.
- Minimum of five years clinical Nursing in an acute care setting.
- Knowledge of regulatory and payer requirements for reimbursement and reasons for denials by auditors.