St. John's Riverside Hospital

Senior Director of Denials Management

Job ID
2017-2674
Andrus
Category
Nursing
Position Type
Regular Full-Time
Hours Per Week
37.5
Shift
Day
Work Shift
Days
Posted Salary
Negotiable

Overview

St. John's Riverside Hospital is a leader in providing the highest quality, compassionate health care utilizing the latest, state-of-the-art medical technology. Serving the Westchester community from Yonkers to the river town communities of Hastings-on-Hudson, Ardsley, Dobbs Ferry and Irvington, St. John's Riverside has been and continues to be a unique and comprehensive network of medical professionals dedicated to a tradition of service that spans generations.

 

St. John’s has been an integral part of the community since the 1890's and its’ commitment to provide the community with the most advanced medical services available continues to be the hospitals’ vision, mission and value. St. John's Riverside Hospital built itself around an early foundation of nursing and community service. In 1894, the Cochran School of Nursing, the oldest hospital-based school of nursing in the metropolitan area, was founded, thus making the St. John's Nursing Staff more than just the backbone of the hospital, but the heart and soul. St. John’s dedicated nurses give superior attention to those who need it most with a strong emphasis on patient and family-focused nursing care.   

 

St. John’s Riverside Hospital staff is committed to making life better for all patients. The hospital continues to elevate the services provided with the goal of increasing the quality of  life for all who entrust St. John's Riverside Hospital to their care.

 

Personalized care together with advanced technology is what it means to be Community Strong

 

Responsibilities

Directly manages all payer denials working with the AVP of Revenue Cycle. Oversees the Case Management and Clinical Documentation Departments including Denial Management Vendor working to enhance reimbursement and decrease denials.

 

Job duties include the direct oversight of all Denials. The AVP will oversee the Director of Case Management who manages discharge planning and utilization review of cases, including those with Medicare, Medicaid, HMO and private coverage. Directs development of specific short and long range programs and project plans to achieve the facility’s goals and objectives. Establishes department policies and procedures. Establishes best practices for department and staff. Responsible for overseeing patient Length of Stay. Prepares monthly statistics and manages department database. Ensures staff is trained and using Milliman and InterQual Criteria. Coordinates the Utilization Review process and participates in related interdisciplinary committees and working groups. Coordinates the review and response process for denials.  Implements process to avoid hospital denials. Responsible for the planning and coordination of department activities, the operational efficiency and effectiveness of the department. Responsible for hiring, firing, discipline and performs performance appraisals for Director of Case Management and Director of Clinical Documentation. Responsible for ensuring the department meets and adheres to all applicable federal, state, JCAHO, and local regulatory agency requirements. Participates on various committees and other task forces as may be established by management to plan, organize and drive the facility. Prepares the performance improvement reports quarterly for presentation at Performance Improvement committee meeting. Confers with other department directors when necessary to resolve procedural difficulties, clarifying department responsibilities, objectives and resolving identified problems. Makes recommendations on insurance company contract initiation, renewals and terminations. Responsible for preparation and overall management of the annual budget for the department.

Qualifications

Registered Nurse with a current valid NYS license. BSN required; MSN preferred. Must possess a minimum 3 to 5 years of acute care leadership experience, two of which as a Manager or Director of Case Management.

 

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