Job Description

We are seeking a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) or other healthcare professional to work in a full-time, permanent position as a Director of Case Management with a healthcare organization located in the Greater Nashville, TN Area.

About the Opportunity:

This position will allow you to carry both your knowledge and expertise in case management while allowing you to directly impact patients and their families. Make a difference today!

Join a well-respected, health care organization that specializes in providing acute care services to the community it serves. This organization offers an opportunity to grow within a stable, established company.

Job Responsibilities:

· This position is a day-time, Monday through Friday, 40 hours/week position

· LCSW or RN will assume responsibility for the overall functions and professional growth of the department including but not limited to Utilization Review (UR) and Resource Management, discharge planning, treatment plan management and financial management

· LCSW or RN will work in an acute care hospital setting

· LCSW or RN will be expected to carry a small case load in conjunction with management responsibilities

· LCSW or RN will supervise Case Managers and PRN staff and participate in conducting patient treatment plan development to ensure patients have the best possible experience. Assures all patients and families are greeted and have adequate explanation of case management function within 24 hours of admission

· LCSW or RN will develop strong relationships with both referral source and payor and takes on the responsibility of guaranteeing satisfaction of each. Effectively interacts with patients, families, and visitors to enhance guest relations. Participates in referral development and other marketing activities as appropriate. Identifies and meets payor requirements 100% of the time. Assures team is notified immediately and educated on payor requirements

· LCSW or RN will handle all financial responsibilities related to the position/department. Assures department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient. Assures payor-friendly systems are in place to promote prompter payments while reducing the facility's financial risk. Assures the department maintains demonstrated effort of cost to charge based conversions as required by the Medicare program

· In conjunction with the CBO, assures the completion of Medical Necessity denial appeals within the specified timeframe. Maintains at least a 75% inpatient denial reversal rate. Assures all national and local contract requirements are identified and fulfilled. Assists CBO in effort to maintain updated contract manuals at corporate