Director Registered Nurse (RN) - Case Management
North Central Baptist Hospital
San Antonio, TX
3x12 hrs

The Director of Case Management is responsible 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, patient, families and caregivers. Completes established competencies for the position within designated introductory period. Other related duties as assigned.

The individual’s responsibilities include the following activities:
a) manage department operations to assure effective throughput and reimbursement for services provided,
b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy,
d) ensure timely and effective patient transition and planning to support efficient patient throughput,
e) implement and monitor processes to prevent payer disputes,
f) develop and provide physician education and feedback on hospital utilization,
g) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.

MINIMUM EDUCATION: Bachelor’s Degree from an accredited school, college or university as a Registered Nurse 
PREFERRED EDUCATION: Master’s Degree from an accredited college or university in Nursing or related field
MINIMUM EXPERIENCE: 2 years in acute hospital case management, healthcare or leadership experiences 
PREFERRED EXPERIENCE: 5 years in acute hospital case management. McKesson InterQual® experience and Business Planning experience
REQUIRED CERTIFICATIONS/LICENSURE: Possession of current Texas State registration as a Registered Nurse 
PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)
REQUIRED COURSES/ COMPLETIONS (e.g., CPR): NA