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Case Management Consultant

Remote, USA
Classification:  Contract
Contract Length: 12-months
Job ID: #12613147

At CereCore, our heart for healthcare is interconnected with our knowledge of technical solutions, creating a vital link that ultimately drives the delivery of high-quality care. CereCore is a wholly-owned subsidiary of Hospital Corporation of America (HCA) Healthcare.  

CereCore is seeking a Case Management Consultant to join our team in Nashville, TN. This individual will work remotely for a large healthcare organization implementing MEDITECH across multiple facilities.
 
Summary: 
The Case Management Manager Standards and Process Validation is primarily responsible for carrying out the day to day operations related to standards and process validation throughout the case management department, with a focus on government regulations and case management processes. The manager will assist in tracking data, noting trends, and identifying improvement opportunities through IRR, chart reviews and the quality assurance program.
The Manager must be a subject matter expert in Case Management and will facilitate process standardization to promote improved outcomes, maximize resource utilization, and improve organizational efficiencies. As an essential element to the overall success of the Case Management Program, the Manager consistently demonstrates a strong work ethic and commitment to excellence. This position requires the ability to function with moderate supervision in a rapidly changing environment and to serve as a subject matter expert to the Case Management departments within HCA. 

Responsibilities:  ​
  • Provides ongoing evaluation and assessment of Facility practices and industry changes to ensure the enterprise remains current in processes
  • Assists in the design, development, implementation, evaluation, and revision of programs and processes developed for case management, including a focus on government payers, CMS regulations, managed care contracts and other applicable legal regulatory requirements as defined by federal and state regulations and company policy.
  • Performs review of procedures, analyzes evidence, reaches conclusions, identifies issues, develops strategies, and makes decisions for complex, judgmental issues in conjunction with the director, related to the review procedures executed. Consults with others in the Company, in conjunction with the director, as necessary, on complex issues
  • Develops detailed reports specifying gaps identified during monitoring
  • Assists the facility with action plan development and follow-up questions as requested
  • Offers suggestions and recommendations to resolve program challenges and obstacles
  • Collaborates with other members of the Corporate Case Management, Regulatory Department, JCAHO, and Physician Teams to develop policies and procedures to support systems, standards of practice, regulatory standards, and evidence-based best practices
  • Provides daily support and subject matter expertise to Facility and Division leadership, and identifies areas of opportunity for continuous improvement including ongoing education and resources as needed
  • Conducts ongoing research to remain current in evidence-based best practices
  • Assists in the development of Utilization Management Program tools needed to streamline processes and reporting
  • Works in collaboration with Corporate Compliance
  • Maintains and articulates current knowledge and understanding of all corporate policies and procedures related to job function
  • Performs other duties as assigned
  • Establishes and maintains effective and positive relationships which promote teamwork
  • Practices and adheres to the “Code of Conduct” philosophy and “Mission and Value Statement”
Position Requirements:
  • Bachelor’s degree is required.
  • 5+ years of MEDITECH Expanse Case Management experience required.
  • Experience in full EHR lifecycle consulting required.
  • Experience with MEDITECH Expanse/6.16x/6.15x Case management.
  • Experience in participating in project teams defining project requirements for their area of expertise.
  • Experience in participating with project team or independently with general/moderate supervision to complete project work.
  • Intermediate to Expert ability to work in Office suite products: Outlook, Word, Excel, Visio, and Power Point
  • Good organization skills.
  • Good written and oral communication skills. 
  • Experience working in a team-oriented, collaborative environment.
  • A sense of responsibility and accountability; someone who takes ownership and initiative.
  • Adaptable and flexible.
  • Professional demeanor and positive attitude; customer service orientation.
  • Ability to learn new technologies, methods, and processes.
  • Respect for diversity of experience, characteristics, viewpoints, and opinions.
QUALIFICATIONS:
  • Strong clinical background with 5+ years acute care nursing experience required
  • Relevant case management experience required
  • Audit and chart review experience required
  • Knowledge and understanding of Medicare IPPS rules and regulations
  • In-depth knowledge of case management, discharge planning, and utilization review practices and ability to incorporate current trends successfully
  • Knowledge and understanding of governmental and JCAHO regulations
  • Must have strong clinical, analytical, written, verbal and presentation skills
  • Ability to communicate effectively in oral, written and electronic formats
  • Ability to establish and maintain collaborative and effective working relationships with a focus on the importance of teamwork
  • Travel 40%


CERTIFICATE/LICENSE:  
  • Registered Nurse (RN) with current state licensure, BSN
CereCore was formed in 2001 as a shared service business within a large hospital operator.  We focus solely on helping healthcare organizations align business and IT strategies to improve processes and patient care. 

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