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Director of Care Management - RN

Geneva, NY · Healthcare · 160000
  • Salary in the $115 - 160,000 range DOE
  • Comprehensive Benefit and Retirement Programs. 
  • Relocation Assistance 

We are seeking a qualified candidate for the position of Director of Care Management at our Geneva, New York location. The successful candidate will oversee professional and clerical staff engaged in various functions, such as access, pre-authorization, bed placement, coding, utilization review, denial management, care coordination, collaborative treatment planning, core measures, discharge planning, clinical social work, post-acute period tracking, disease management, and internal/external contracting.

Responsibilities:

  • Supervise and lead a team responsible for diverse functions within the department.
  • Collaborate with the Chief Medical Officer (CMO) to foster effective relationships with physicians, services, and specialties.
  • Provide consultation to the executive team and establish effective relationships with all VPs and department leaders.
  • Contribute to the definition of the Care Management Dashboard, utilizing data for strategic decision-making.
  • Develop and implement a strategic plan for the department, considering internal and external factors.
  • Manage staffing levels, assignments, skills, learning needs, and staff deployment.
  • Establish stable processes to address specific situations within the department and coordinate with other departments and agencies.
  • Foster communication with third-party payers, the local PRO/QIO, Medical Records, and managed care and finance offices.
  • Develop structures and processes to facilitate multidisciplinary care planning and delivery involving various health professionals.
  • Participate in continuous quality improvement initiatives.
  • Negotiate, approve, and manage operational and capital budgets.
  • Conduct annual and interim performance appraisals for department staff.

Essential Job Functions:

  • Develop, implement, and evaluate denial management strategies to reduce denials and recover revenue.
  • Actively participate in revenue activities related to clinical care delivery.
  • Establish effective working relationships with regional payer representatives.
  • Develop and implement strategies for 30-day readmissions, length of stay, and cost reduction.
  • Manage the discharge planning process to ensure an interdisciplinary approach and appropriate patient care levels.
     

Who Will Be a Great Fit? 

  • Bachelor's degree in Nursing (BSN), Masters preferred.
  • Active New York State License to practice as a Registered Professional Nurse.
  • 5+ years of RN experience.
  • 3+ years of experience in utilization management or denial management.
  • Knowledge and experience in developing utilization management and revenue recovery strategies.
  • Experience in dealing with authorizations and appeals processes.
  • Knowledge of discharge planning and clinical case management strategies.
  • Experience in project management and team dynamics.
  • Knowledge of basic research methods and statistical analysis.
  • Familiarity with DRGs, Medicare Regulations, Medical Necessity Criteria, Patient Bill of Rights, and HIPAA.


About the Area:
Situated in the scenic Finger Lakes Region of New York State, Geneva offers a beautiful natural environment, renowned wine trails, a rich history, and four-season attractions. Enjoy proximity to quality colleges and universities with a short drive. Join our team and be part of a vibrant community!


As recruiters, we are skilled in our field and understand how to match an opportunity with the individual. If you choose to send us your resume, be advised we will not share it with any employer without your permission. 

If this isn't the right position for you, please share it with someone who might be interested. In the meantime, please look at our website – we have other openings that may suit your needs!

Thank you,

Brian Hughes
https://www.greatbaystaffing.com

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