Job opening for a Case Manager Supervisor in a 150 bed hospital located in Texas.
Responsible for the coordination and direction of all utilization management activities to support and implement the goals of the utilization management program and plan. Maintains responsibility for the review of all usage patterns for medical necessity and appropriateness of care against screening criteria and for infection control, quality and risk assessment documenting same in computerized database. Responsible for authorization of appropriate services; inputs authorizations and utilizes utilization management component of computer system. Coordinates the discharge planning function in conjunction with the discharge planner/social worker, assist Quality Management Coordinator and Risk Manager with screening, investigation and problem solving as needed. Assists the medical director with all utilization activities as requested and directed. Prepares agenda and meeting packet for the Utilization Management Committee and documents a summary of the meeting contents in committee minute format. Responsible for education on and implementation of clinical guidelines and protocols. Responsible for coordination and presentation of utilization management program for all HMO due diligence and routine utilization management audits. Directs CQI activities and performance improvement activities within the department. Performs other duties as assigned. This position reports to the Director.
- Current State of Texas Registered Nurse Licensure.
- Three or more years utilization management experience in the managed care environment.
- Five or more years acute hospital, home health, hospice, inpatient mental facility experience required.
Competitive Salary Range!
Executive & Management Recruitment Services