Director of Revenue Intelligence leading AI - powered revenue intelligence programs at Pax8. Transforming revenue workflows and driving growth in the United States.
About the role
- Director of Care Management overseeing multidisciplinary teams to optimize patient transitions and care coordination in healthcare. Leading initiatives to improve care delivery and compliance standards.
Responsibilities
- Directs the overall care management program, including case management, social work, and utilization review.
- This involves setting departmental goals, establishing policies, and managing budgets.
- Maintains collaborative relationship with Medical Staff and facilitates education on documentation, government regulations and payer contracting matters.
- Oversees processes to ensure patients are at the correct level of care (e.g., observation vs. inpatient) and that hospital resources are used efficiently.
- Lead the Utilization Management Committee to report on denial trends and resource consumption.
- Assures hospital adherence to all Federal, State, and Local regulatory and compliance guidelines related to utilization.
- Oversight of critical processes related to compliance of both medical necessity and appropriate level of care; coordinates utilization review processes to assure adherence to regulations.
- Supports the Utilization Management and Appeals Supervisor and the Manager of Care Management to assure the functions of care coordination in the acute setting meet the goals of resource consumption, capacity management and patient centered care.
- Develops programs to support length of stay initiatives to manage capacity and assure the right care at the right time.
- Assures hospital adherence to all regulatory guidelines related to discharge planning.
- Continuously seeks best practice approaches to assuring patients are discharge ready including coordination of services, coaching, and transition of information.
Requirements
- Master of Science in Nursing (MSN) degree from an accredited school of nursing required.
- Current Registered Nurse license by Pennsylvania Board of Nursing or Compact State.
- At least 3-5 years' leadership experience in case management.
- CCM (Certified Case Manger) or ACM (Accredited Case Manager) preferred.
Benefits
- Comprehensive benefit packages, including medical, dental, vision, mental health, paid time off, 403B, education assistance and voluntary benefits (pet insurance, accident insurance, hospital indemnity and others) available from the first day of employment.
- Work/Life balance with flexible schedules.
- Free onsite parking.
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
Global Real Estate Sr Director overseeing property strategies and regional team collaboration at Johnson & Johnson. Directing real estate activities and ensuring alignment with global business strategies.
Global Facility Management Sr Director leading operational excellence across 100+ locations in healthcare facilities. Innovating risk management and compliance, while driving energy management initiatives.
Director of Customer Strategy at Kenvue responsible for defining sales strategies and driving customer engagement across brands. Leading cross - functional teams and ensuring alignment with enterprise priorities.
Senior Director of Enterprise Strategy at Zelis modernizing healthcare financial experiences. Driving strategic development and competitive positioning across various business units.
Director of Physician Organization Analytics at Highmark Health, leading comprehensive reporting and operational insights. Collaborating with stakeholders to ensure data accuracy and empower data - driven decisions.
Health and Wellness Director responsible for resident care and managing health services in a senior living community. Overseeing care coordination and collaboration with healthcare professionals.
Senior Director managing Warehouse and Labor Management Systems technology strategies at McKesson. Ensuring operational efficiency within the distribution network and spearheading modernization efforts.
Senior Director leading Pricing Transformation at HP's Global Pricing Operations team, elevating pricing to a strategic lever for revenue growth.
Assistant Director leading operational and administrative functions for behavioral health and treatment services at Sieda Community Action in Ottumwa, Iowa, focusing on compliance and grant writing.