Manager of Case Management
Manager of Case Management
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Salary Not Disclosed
1 Vacancy
Job Description
Job Summary
Manager of Case Management in the departments activities and resources to achieve departmental and organizational objectives and will take the lead in the absence of the Director. Accountable for the execution adaptation and outcome of care management as described in the initial UM plan with regard to resources appropriateness of care and adherence to a designated GMLOS for each patient.
COMPANY DESCRIPTION
Frye Regional Medical Center located in the beautiful foothills of North Carolina is a 355-bed acute care hospital 81-bed Behavioral Health facility and more than 70 primary and specialty care providers.
Essential Functions
1. Monitors the daily assignment and makes adjustments as needed to maintain an evenly distributed caseload for CM SWs and D/C Planners
2. Keeps staff up to date on their time in kronos; fixes missed punches
3. Takes messages off insurance line and communicates information to correct persons.
4. Completes Retros as needed and enters days authorized into Cerner for billing purposes.
5. Enters billing changes into Cerner so billing knows correct way to bill; ie direct admits or bill different than status
6. Researches medical records to assist if business office or coding department has questions; also assists revenue integrity with questions
7. Monitors all OBS patients to remain <24hrs
8. Follows discharges daily to make sure all days authorized for hospital stay.
9. Scribes for IDT Meeting daily and quarterly UM committee meetings
10. Performs monthly audits as designated by the DCM; MCL and Patient choice; also completes missed final dispositions paperwork.
11. Notifies DCM and business of denials and enters on a denial log.
12. Fights denials by not accepting if not appropriate and constantly sending updated information and asking for re-reviews.
13. Assist UR as needed with sending clinicals to insurances to keep information timely
14. Participates in the hiring of new employees as well as managing current staff needs
15. Resource person for post-acute services.
16. In director absence attends morning huddle morning throughput meetings regarding dc for the day.
17. Is involved if and when state comes on site.
18. Attendance Policy
19. Communications
Benefits -Wide range of benefits options!
- Here at Fryeyou choose your ownMedical Dental and Vision plans from a variety of competitive options that give you the coverage that best fits your needs.
- HSA
- 401(K) retirement plan contributions
- Generous Paid Time Off
- Accident & Critical Illness Insurance
- Prescription Assistance with OptumRx
- Income protection programs for the entire family such as life insurance Short/Long-term Disability and Identity Theft.
- Employee Assistance program at no cost to you to provide emotional legal financial and daily life support for your entire are available 24 hrs. a day 7 days a week.
- Free travel and entertainment discount program to ensure you enjoy your time away from work.
Why join our team
Frye Regional Medical Center employs more than 1500 professional and clinical medical center is a 355-bed acute care facility which offers a broad array of inpatient and outpatient Regional Medical Center is dedicated to providing patients with a full range of services to meet the healthcare needs of our believe our employees are our most valuable assets in accomplishing this goal and we have made great strides to ensure employee you are passionate about changing lives we are looking for you!
Minimum Education
Associates Degree in Nursing required
Bachelors Degree in Nursing preferred.
Licenses: Current RN license to practice in NC (NC licensure or multi-state (compact) license).
Minimum Work Experience
Five years hospital- based clinical experience. Experience in Case Management Utilization Review and/or Discharge planning knowledge of Interqual and other payor criteria required. Must have excellent communication skills demonstrate self-direction and have the ability to work well in a team environment.
Required Experience:
Manager
Employment Type
Full-Time
