Our patients are our number one priority! We're committed to giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional Posting Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention + Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction + Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at the appropriate level of care + Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy + Education provided to physicians, patients, families and caregivers + 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 and revenue cycle processes are completed accurately and in compliance with CMS regulations, Texas Medicaid and SRC 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. Required Skills/Abilities: + Bachelor degree in Nursing or Health Care Administration for RN required + MSN, MBA, or MHA preferred + 3 years of acute hospital case management or healthcare leadership experience required. + 5 years of acute hospital case management leadership including surgical and critical care patients preferred + Registered Nurse. Must be currently licensed, certified or registered to practice profession as required by law or regulation in Texas required. + Accredited Case Manager (ACM or other certification) preferred At Scottish Rite for Children, we work together with the common goal of helping give children back their childhood. Scottish Rite is a unique place to work because we believe in a collaborative approach, utilizing the care and expertise from all departments. We are always looking for caring, energetic individuals to join our team. We currently have locations in Dallas and Frisco and is an equal opportunity employer. For questions, contact careers@tsrh.org.