NHS Solutions has a exciting opportunity for an Interim Director of Case Management. Job responsibilities include:
- Manage department operations to assure effective throughput and reimbursement for services provided
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
- Ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and policy
- Ensure timely and effective patient transition and planning to support efficient patient throughput
- Implement and monitor processes to prevent payer disputes
- Develop and provide physician education and feedback on hospital utilization
- Ensure compliance with state and federal regulations and TJC accreditation standards
- Other duties as assigned
