Registered Nurse Case Management Services Director

Job Number
213032
Banner Health (Corporate)
Shift
Day
Department
Banner Health (Corporate) - Case Mgmt-Corp
Position Type
FT: Full-Time
Internal Code A
COREHTF
Street Address
2901 N. Central Ave
City & State
US-AZ-Phoenix
Posting Category
Leadership - Nursing

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Banner Health is looking for an RN Director to join their Case Management Team.  

 

This Director position requires oversight and management of operation over Utilization review, concurrent review and denials management activities.

 

 

The ideal candidate would have the below experience

  • Requires a current AZ Registered Nurse (R.N.) license
  • 2 plus years of Case Management Leadership experience
  • Inpatient Case Management experience a plus
  • Utilization review experience 
  • Denials management experience 
  • Experience with MCG or InterQual 
  • Commercial payer experience would be ideal

 

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About Banner Health Corporate
Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care.

 

Truven-2013
Stage7-2013

About Banner Health
Banner Health is one of the largest, nonprofit health care systems in the country and the leading nonprofit provider of hospital services in all the communities we serve. Throughout our network of hospitals, primary care health centers, research centers, labs, physician practices and more, our skilled and compassionate professionals use the latest technology to make health care easier, so life can be better. The many locations, career opportunities, and benefits offered at Banner Health help to make the Banner Journey unique and fulfilling for every employee.

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Job Summary

This position is responsible for the development and implementation of case and utilization management programs and services. This position provides leadership, direction and support for Case Management Services in the pursuit for best practice to achieve quality outcomes, reduce costs, and shape and interpret the standards required to ensure a high degree of patient, physician and employee satisfaction. This position may also have responsibilities for other facility/entity-specific patient outcomes.

 

Essential Functions

  • Plans, directs and monitors the case and utilization management program(s). Provides advice, counsel, feedback and coordination to promote a collegiality between staff, physicians and the leadership team.

 

  • Ensures that development of case management services across the continuum leads to outcomes supportive of the organizations strategic plan. Designs and implements processes to ensure appropriate care coordination in accordance with regulatory and standards of safety.

 

  • Provides direction for multidisciplinary process improvement activities, including the establishment of performance measures to attain optimal clinical, operational, financial and satisfaction outcomes. Directs the collection, analysis and presentation of data on utilization patterns and other program outcomes.

 

  • Directs personnel actions including recruiting, new hire actions, interviewing and selection of new staff, salary determinations, training, and personnel evaluations. This position also participates in the development of Case Management goals and objectives in accordance with company standards.

 

  • Manages the financial and capital resources for case management services by monitoring operating revenue and expenses, establishing and maintaining cost control programs and developing and implementing new or revised programs and/or services. Develops and implements strategies to work with all external customers to ensure appropriate reimbursement.

 

  • Develops and oversees the department budget in conjunction with corporate goals and objectives. This position is accountable for meeting annual budgetary goals.

 

  • Assesses patient satisfaction in areas of responsibility; sets a high standard for staff and leadership to improve patient satisfaction as measured by survey scores.

 

 

Minimum Qualifications

BSN or MSN required for all new hires to the position after October 1, 2016. Incumbents in the position prior to October 1, 2016 must possess a bachelors degree in a related field.

Requires a current Registered Nurse (R.N.) license in state worked. In an ambulatory setting, a CCM (Certified Case Mgr) must be obtained within 3 years of accepting position.

Must have considerable experience with appropriate age specific patient population in the area of responsibility as typically demonstrated through at least 2 years of management experience and two years of providing direct, clinical care in a patient setting.

Must possess demonstrated flexibility in responding to the needs of multiple constituencies with a service-oriented philosophy. Must also possess demonstrated skill in problem analysis, project management, contract negotiation, conflict resolution and oral/written presentation. Requires strong working knowledge of utilization management, care management, regulatory standards and reimbursement across the continuum of care.

Preferred Qualifications

Masters degree in nursing or business is preferred; Managed care experience is a plus; CCM (Certified Case Mgr).

Additional related education and/or experience preferred.