Director Registered Nurse; RN - Case Management

Atrium Health Charlotte is seeking a Registered Nurse (RN) Case Management Director for a nursing job in Charlotte, North Carolina.

• Specialty:
  Case Management
• Discipline:
  RN
• Start Date:
  
  ASAP
• Duration:
  Ongoing
• Employment Type:
  
  Staff

Overview

Job Summary

Oversees components necessary to maximize access to services for the patient population served. Monitors payment processing system, audits and appeals, quality assurance, and compliance functions. Serves as a resource to administration for data analysis and regulatory information for use in operational decision making. Supervises staff.

• Coordinates performance review for appropriateness of patient services and care team processes according to hospital standards and policies.
• Oversees development of facility, physician, and program specific outcome reports for the purposes of performance improvement.
• Reports actions to and obtains recommendations from an Advisory committee.
• Directs the coordination of payment system processes including maintaining and negotiating outcome of system contracts.
• Coordinates quarterly compliance audits, and the audits and appeals process to ensure highest probability of appropriate reimbursement for services delivered to our persons served.
• Tracks payer reimbursement patterns to ensure accurate and appropriate payment as needed.
• Directs the clinical care coordinators who interface with payers as needed to assure payment of services.
• Provides support and intervention as needed to ensure patients are able to access required services without financial hardship.
• Performs or delegates performance of documentation audits as needed to ensure clinical documentation meets compliance standards.
• Recommends and assists with changes to documentation systems to ensure compliance with the frequently changing requirements of the division.

Frequent walking, standing, sitting. Ability to speak fluent English. Intact sense of sight, hearing, smell, touch, and finger dexterity. Critical thinking and ability to concentrate. Ability to lift and move reports weighing up to ten pounds. Flexibility in covering multiple sites.

Certificate of attendance to training workshop on the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) preferred. Bachelor's Degree in Finance or Healthcare related field required;
Master's degree preferred. At least 3 years of related work experience required.

Atrium Health Charlotte Job . Posted job title:
Director - Case Management

Headquartered in Charlotte, NC, Atrium Health is now part of Advocate Health, the third-largest nonprofit, integrated health system in the United States, which was created from the combination with Advocate Aurora Health. In the Southeast Region, Atrium Health provides care under the Atrium Health name in Charlotte, NC, Atrium Health Wake Forest Baptist name in the Winston‑Salem, NC, region, as well as Atrium Health Navicent and Atrium Health Floyd in Georgia and Alabama.

Together, we are committed to providing equitable care for all. Annually, Advocate Health provides nearly $5 billion in community benefits.

Atrium Health Wake Forest Baptist is a pre‑eminent academic health system based in Winston‑Salem, North Carolina. Atrium Health Wake Forest Baptist is part of Advocate Health, which is headquartered in Charlotte, North Carolina, and is the fifth-largest nonprofit health system in the United States, created from the combination of Atrium Health and Advocate Aurora Health. Atrium Health Wake Forest Baptist's two main components are an integrated clinical system – anchored by Atrium Health Wake Forest Baptist Medical Center, an 885‑bed tertiary‑care hospital in Winston‑Salem – that includes Brenner Children's Hospital, five community hospitals, more than 300 primary and specialty care locations and more than 2,700 physicians;

and Wake Forest School of Medicine, the academic core of Atrium Health Enterprise and a recognized leader in experiential medical education and groundbreaking research that includes Wake Forest Innovations, a…