St. Dominic Hospital

Receive alerts when this company posts new jobs.

RN Manager Care Management

at St. Dominic Hospital

Posted: 12/3/2018
Job Status: Full Time
Job Reference #: 8695

Job Description

Location: St. Dominic Hospital
Department: CARE MANAGEMENT - 9740
Employment Type: Full Time 80
Shift: Day
Other Shift Details:
Job Code: 8695

Manager of Care Management

Job Summary

The Manager of Care Management provides leadership of the utilization management process and clinical documentation integrity program. This position maintains operational oversight with 24 hour accountability for the assigned areas within Care Management.

Required Education and Experience

RN with a Bachelor's Degree in Nursing

Minimum of 3 years experience in Case Management


Job Duties


1.            Demonstrates the ability to maximize financial outcomes associated with utilization management, resource management, delays, denials, medical necessity, and level of care determinations.

2.            Coordinates and integrates quality review activities pertaining to medical necessity, level of care, resource utilization, system management, analysis and evaluation in an effort to enhance operating  efficiencies.

3.            Analyze data, prepares variance reports, and monitors departmental and organizational records in order to ensure prudent resource and utilization management.

4.            Evaluate treatment plans for over/under utilization of services as they relate to cost effective delivery of care to facilitate appropriate reimbursement through third party payor contracts.

5.            Responsible for training new employees and on an ongoing basis in the application of medical necessity screening criteria (Interqual) to all staff assigned  to utilization  management activities.

6.            Maintains relationships with payors to facilitate communication regarding processes to ensure timeliness of authorizations and reimbursements.

7.            Educates all departmental staff responsible for medical necessity documentation in the requirements on an ongoing basis and maintains current on regulatory  requirements  in order to ensure  compliance.

8.            Responsible for interviewing, hiring, orienting, training, evaluating

performance and disciplinary activities as required in personnel management activities.

9.            Provides current and ongoing education on the clinical documentation integrity program to ensure capture of documentation in the medical record  to promote  increased  reimbursement practices.

10.         Tracks and trends data for the clinical documentation integrity program to analyze financial trends and opportunities to focus process improvement efforts.

11.         Manages, ensures competencies, and evaluates through auditing activities of assigned staff.

12.         All other duties as assigned in the management of the daily departmental operations.



Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!