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Financial Analyst

Jennie Stuart Health

Financial Analyst

Hopkinsville, KY
Full Time
Paid
  • Responsibilities

     JOB SUMMARY

     

    Responsible for functional and operational aspects of the Case Management department, to include; ensuring organizational priorities are appropriately addressed, managing the daily department operations while promoting quality, productivity, and efficiency. The Manager, Case Management will provide guidance to staff as well as the multi-disciplinary care team in areas of improved patient care, clinical effectiveness, cost reduction, patient satisfaction, and patient flow and throughput. In addition, this role will be responsible for staffing, budget compliance, coaching, counseling, and education. Will assure compliance with accreditation/regulatory/government regulations and support the mission, vision, and values of Jennie Stuart Medical Center.

    Essential Functions

    • Manage department activities to ensure staff has proper resources and education to perform their respective job.
    • Performs management responsibilities of selection, scheduling, supervision, retention, and evaluation of department employees.
    • Oversee discharge planning, care coordination, and resource utilization for all patient encounters.
    • Utilize clinical knowledge and judgment to determine appropriate interventions to address patient needs and barriers to patient progression through the continuum
    • Maintain thorough understanding of CMS regulations, as well as other payer processes supporting authorization and identification of correct patient types (Inpatient, Observation, and Outpatient).
    • Support chart audit functions including RAC and third-party requests.
    • Practice autonomously, consistent with practice standards, policy, and procedures.
    • Provide daily leadership to achieve maximum efficiency and top-quality outcomes.
    • Demonstrate creative problem-solving skills, utilizing innovation and a team approach.
    • Demonstrate commitment to continued professional and personal growth.
    • Utilize clinical knowledge and judgment to determine appropriate interventions to address patient needs and barriers to patient progression through the continuum.
    • Demonstrates understanding of utilization management necessity for all patients, regardless of payer status.
    • Track and trend Case Management related metrics, to include those required by regulatory agencies
    • Utilize data analysis to drive process improvement efforts.
    • Proactively identify department interventions and priority expectations to improve case management metrics (LOS reduction, Readmission reduction, discharge times, etc.)
    • Work collaboratively with a multi-disciplinary team to provide high-quality patient care, cost reduction, patient satisfaction, and seamless patient flow and throughput.
    • Assist in oversight of Utilization Management Committee in compliance with CMS and TJC.
    • Act as a liaison to payers and post-acute providers.
    • Participate in department/organizational performance improvement activities.
    • Provide leader/mentorship for all areas of the Case Manager and Social Work roles.
    • Promote effective and efficient utilization of clinical resources.
    • Assist in maintaining department budget and ensure that department operates in a cost-effective manner.
    • Promote effective and efficient utilization of clinical resources.
    • Implement strategies to achieve financial targets and staffing needs through optimizing productivity, resource efficiency, minimizing overtime, and any other areas, as needed.
    • Actively provides and monitors the training of all new departmental staff.
    • Ensure staff remains compliant with annual education requirements, such as Safety, HIPAA, Code of Conduct, etc.
    • Maintain compliance with applicable laws, regulations, and standards that affect the organization (TJC, CMS, State mandates).
    • Take an active leadership role in hospital-wide projects.
    • Demonstrate commitment to the mission, vision, and values of the organization.

    Required Skills

    MINIMUM EDUCATION: Graduate from an accredited nursing program.

     

    REQUIRED DEGREE: Bachelor’s degree in Nursing. ACM or CCM Certification preferred.

     

    WORK EXPERIENCE: Must have minimum 5 years acute care clinical experience, 2 years in Case Management with 1-year management experience a plus. Strong clinical and communication skills. Experience with InterQual criteria preferred

     

    LICENSURE: Licensed to practice in State of Kentucky. Current BLS Certification required.

     

    REQUIRED SKILLS: A demonstrated knowledge and understanding of Medicare/Medicare Advantage, Medicaid, commercial insurance, and other third-party reimbursement processes. Proven analytical, leadership, organization, problem-solving skills. Excellent customer service skills.

    Required Experience

  • Qualifications

    MINIMUM EDUCATION: Graduate from an accredited nursing program.

     

    REQUIRED DEGREE: Bachelor’s degree in Nursing. ACM or CCM Certification preferred.

     

    WORK EXPERIENCE: Must have minimum 5 years acute care clinical experience, 2 years in Case Management with 1-year management experience a plus. Strong clinical and communication skills. Experience with InterQual criteria preferred

     

    LICENSURE: Licensed to practice in State of Kentucky. Current BLS Certification required.

     

    REQUIRED SKILLS: A demonstrated knowledge and understanding of Medicare/Medicare Advantage, Medicaid, commercial insurance, and other third-party reimbursement processes. Proven analytical, leadership, organization, problem-solving skills. Excellent customer service skills.