NHS Solutions has an immediate opening for an Interim Director of Case Management in the New England area. Our client is looking for an Interim Director of CM who is hands on and can analyze data. Reporting directly to the Vice President of Clinical Operations, the Interim Director of Case Management will provide clinical and administrative leadership to the Department of Case Management with responsibility for Utilization Review, Integrated Clinical Service and Discharge Planning. The successful candidate will effectively utilize established medical necessity criteria for admissions and transitions of care, length of stay and readmissions, with specific focus on high risk populations. Must possess in depth knowledge of Medicare, Medicaid and commercial claims review and denial processes, with administrative accountability for appeals preparation and submission.This is an initial 3 month assignment in a department that is running smoothly with a collaborative culture.
- RN license in the State
- BSN, MSN preferred in Health Care Administration, Business Management or related health care field
- Certification in Case Management preferred