Director Denial Management and Prevention (RN)

$114,004 - $219,960 / year

About this Job: General Summary of Position

The Director Denial Management & Prevention is responsible for directing and administering the programs and activities of a denial prevention and recovery operations. In partnership with the VP Clinical Resource Management the Director will lead planning and execution of strategic initiatives around technical and clinical/medical necessity denials and appeals across system hospitals.

Primary Duties and Responsibilities

Collaborates with VP Clinical Resource Management and other leaders to identify denial mitigation opportunities andreimbursement improvement processes.

Oversees and directs appeals for the system to include oversight of any appeal vendors.

Partners with system leaders to create implement and sustain improvements that contribute to the organization's goals.

Provides strategic direction and clinical oversight for hospital denials and appeal operations and outcomes.

Works with organization leaders to develop performance goals and objectives based on industry best practices andsystem benchmarks.

Develops and maintains analytics and dashboards to standardize entity denial summaries.

Supports system denial mitigation projects and serves as a consultant for individual entities regarding denial trends andinterventions.

Works with Acute Case Management teams focusing on operational improvements and team education to support denialreduction.

Collaborates with the Managed Care team to summarize and address payer opportunities.

Works with Corporate Compliance and Rates and Reimbursement team to ensure operations and policies conform tocurrent governmental and state regulations.

Manages business partner/vendor contracts holding them accountable to contractual obligations and both industry andorganizational benchmarks.

Supports the optimization of technology to enhance operational efficiency and improve reimbursement.

Minimal Qualifications

Education

Bachelor's degree in Nursing required

Experience

5-7 years 5-7 years of Revenue Cycle experience including appeals and financial clearance required and
Leadership experience in the healthcare industry with emphasis on revenue cycle preferred

Licenses and Certifications

RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Knowledge Skills and Abilities

Team builder with excellent interpersonal skills
Strong analytical and problem-solving skills with high level of accuracy and attention to detail.
Strong verbal and written communication skills including presentation skills with ability to effectively interact with all levels of management internal departments and external agencies.
Computer skills are required to be efficient in managing data (Word PowerPoint Excel and email programs). Advance Microsoft Excel skills.

This position has a hiring range of : USD $114,004.00 - USD $219,960.00 /Yr.

Share this job

Related Jobs

Assistant Director of Nursing Intermediate Care (RN)

MedStar Health Rosedale, MD

$100,588 - $180,419 / year

About this Job: ***Must have experience in IMC or Critical Care Nursing*** General Summary of Position The Assistant Director of Nursing is a member of MedStar Health entity-based Division of Nursing and leadership team. Supports and collaborates with the Director of Nursing in providing leadership and oversight for a specific unit/department. Directs and coordinates the nursing and patient care delivery of the unit-based professional and support personnel. Ensures the provision of holistic, culturally competent, and person-centered, quality, safe, and cost-effective evidence-based nursing care for patients/families. Applies the nursing process within the context of the organization's shared/collaborative decision-making framework. Collaboratively manages the patient's transitions across the continuum of care to assist patients and populations in achieving or maintaining an optimal level of health and functioning. The Assistant Director of Nursing assumes administrative and leadership authority and responsibility during a specific shift (e.g., evening or night) for the assigned unit/department. Fosters associates' commitment to improving quality, safety, and cost-conscious patient care outcomes. Collaborates with the Director of Nursing in maintaining adherence to regulatory and accreditation standards, and MedStar Health's policies and procedures. Demonstrates leadership and behaviors which are consistent with MedStar's mission, vision, goals, SPIRIT Values, patient care philosophy, and sound moral and ethical judgement. What We Offer Culture- Collaborative, inclusive, diverse, and supportive work environment. Career growth- Career mentoring to help you pursue your passions and gain skills to enhance your value. Wellbeing- Competitive salary and Total Rewards benefits to help keep you happy and healthy. Reputation- Regional & National recognition, advanced technology, and leading medical innovations. Minimum Qualifications Education Bachelor's degree in Nursing from a Nationally accredited program required and Master's degree in Nursing or a health related field from a Nationally accredited program preferred Experience 3-4 years progressive nursing care experience required and leadership and management experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid in the State of Maryland or District of Columbia - jurisdiction is dependent on the entity of employment. Upon Hire required and Specialty certification from a nationally recognized nursing organization in either a clinical specialty or Nursing Administration Upon Hire preferred and CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required and Additional unit/specialty certifications may vary by department or business unit. Knowledge, Skills, and Abilities Excellent problem-solving skills and ability to exercise independent judgment on complex situations. Verbal and written communication skills. Basic knowledge of various computer software applications and online learning applications, especially Microsoft PowerPoint and Excel. This position has a hiring range of : USD $100,588.00 - USD $180,419.00 /Yr.

RN Assistant Director of Nursing - Cardiovascular Recovery Unit

MedStar Health Charles Village, MD

$102,606 - $196,996 / year

About this Job: Unit Highlights Seeking Nurse Supervisor to cover Cardiovascular Recovery 29 bed prep and recovery unit, 8 bed radial lounges 24/7 Prep and Recovery Unit Team-oriented, patient centered, and nurturing with primary focus on patient safety Key Responsibilities As a Assistant Director of Nursing, you will be a member of MedStar Health entity-based Division of Nursing's (ADON) leadership/management team and is responsible for one or more defined units/departments of organized nursing and patient care services. You will assume administrative and leadership authority and responsibility for the management and direction of the operational personnel and financial activities of the specified units/departments. Coordinates these functions in partnership with the nursing leadership team Medical Staff and leaders of other departments/disciplines and ensures they are performed in accordance with all applicable laws and regulations and MedStar Health and entity's mission vision and values. Interventions may be delivered directly or coordinated through collaboration with other members of the nursing team Nursing Benefits Nationally recognized nurse wellbeing resources Comprehensive health benefit plans Generous paid time off and flex scheduling options Retirement plans with match Tuition assistance to advance your education Systemwide referral bonus program—up to $6,000 for each RN and up to $4,000 for each LPN that joins MedStar Health Relocation assistance up to $5,000 Free parking for associates Qualifications BSN or MSN, from an accredited School of Nursing required. Prior Clinical Cardiovascular, Perioperative, or ICU Nursing Experience preferred. Active MD RN License or Active Compact State RN and Basic Life Support for Healthcare providers required (AHA or American Red Cross). This position has a hiring range of : USD $102,606.00 - USD $196,996.00 /Yr.

Director of Nursing

Full-time

3 days ago

Registered Nurse (RN) Director of Infection Prevention

MedStar Health Northwest Washington, DC

$120,702 - $238,222 / year

About this Job: General Summary of Position The incumbent in this position is a Director who has administrative responsibility and accountability for the management and direction of the operational personnel and financial activities of the Infection Prevention Department. These functions are coordinated with Hospital Administration Department Heads Medical Staff and others and are performed in accordance with all applicable laws and regulations and MedStar Georgetown University Hospital's philosophy policies procedures and standards. Primary Duties and Responsibilities Administers and maintains all department services in accordance with standards and criteria established by JC CDC and federal state and local governmental agencies including OSHA and CMS. Develops directs and supervises the hospital-wide infection prevention program for prevention of hospital-acquired infections by serving as teacher researcher consultant role model and patient advocate. Serves as Co-Leader of the Infection Prevention Committee responsible for supplying resource information coordinating implementing supervising and evaluating standards of care developed by the committee through liaison to all hospital departments and serves as Infection Prevention resource on/to other hospital committees and Hospital projects as appropriate or deemed necessary. Works collaboratively with other MedStar Hospitals and cross-organizational teams on the planning analysis development of Infection Prevention protocols. Educates personnel on practices regarding prevention of infections. Leads staff in the design implementation and management of medical and infection prevention surveillance programs. Acts as a liaison to the Medical staff for consultative efforts and decisions regarding infection prevention standards and practice. Serves as liaison between hospital-based workgroups and MedStar Corporate Infection Control and works to implement evidenced best practices across the system. Conducts ongoing surveillance with interpretation of data of infection in-patients and personnel and prepares appropriate written reports memos etc. Initiates assists and/or participates in special infection prevention functions e.g. all hospital bi-annual infection prevention policy review and special studies in Infection Prevention. Appraises forecasts and determines desired set of future conditions and strategies required to achieve the goals and objectives of the organization within Incumbent's area of expertise. Assumes overall responsibility (directly or through delegation to other staff members) for personnel management of the departments to include but not limited to: interviewing hiring orienting training scheduling coaching counseling evaluating promoting and terminating employees. Formulates recommends implements monitors and controls operational and capital budgets within administrative guidelines. Collaborates according to Magnet standards with all members of the healthcare team to ensure the achievement of best clinical outcomes. Advocates for and promotes the Magnet standard of culturally-sensitive and competent care for patients families staff and Hospital departments requiring assistance. Assumes other duties and responsibilities that are appropriate to the position and area. The above responsibilities are a general description of the level and nature of the work assigned to this position and is not to be considered as all inclusive. Minimal Qualifications Education Master's degree in Nursing required Experience 10+ years: Minimum 10 years experience in infection prevention inclusive of 7 years of progressive management experience in infection prevention required Fellowship in APIC preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure D.C. licensure as a Registered Professional Nurse. required and CIC - Certified in Infection Control required and Knowledge Skills and Abilities Knowledge of Joint Commission on Accreditation of Healthcare Organization standards Centers for Disease Control and Prevention (CDC) Guidelines the Occupational Safety and Health Administration (OSHA) final ruling on Bloodborne Pathogens Law and other regulatory standards. Must have excellent communication (written and verbal) skills. Must have excellent ability to establish relationships with multidisciplinary teams at all levels of organization. This position has a hiring range of : USD $120,702.00 - USD $238,222.00 /Yr.

Nursing Director (RN) Medicine Telemetry

MedStar Health Northwest Washington, DC

$120,702 - $238,222 / year

About this Job: General Summary of Position The Director of Nursing is a member of MedStar Health entity-based Division of Nursing's (DON) leadership/management team and is responsible for one or more defined units/departments of organized nursing and patient care services. Creates a practice environment that exemplifies the values of patient care and implements a patient and nursing care delivery system which puts the patient first. Recognized as a professional role model who promotes an environment that supports the goals mission vision philosophy and values of the Division of Nursing and MedStar Health. Facilitates the cost-effective utilization of available resources (human material and financial) and ensures a high level of quality of care that is consistent with established standards of nursing practice for the patient populations served. The Director of Nursing assumes 24-hour administrative and leadership authority and responsibility for the management and direction of the operational personnel and financial activities of the specified units/departments. Directs and coordinates the activities of professional and support personnel within the assigned areas. Coordinates these functions in partnership with the nursing leadership team Medical Staff and leaders of other departments/disciplines and ensures they are performed in accordance with all applicable laws and regulations and MedStar Health and entity's mission vision and values. Primary Duties and Responsibilities Creates a professional practice atmosphere and an environment of mentoring and professional development that supports shared/collaborative governance and a high level of associates' satisfaction as evidenced by outcomes data. Builds trusting and collaborative relationships with members of the inter-professional health care team and leaders of other departments. Creates an environment that values opinion sharing utilizes shared decision-making and enhances associates' engagement and retention. Establishes and maintains a therapeutic and safe environment of care delivery that supports the framework of professional nursing practice based on evidenced and to achieve optimum patient care outcomes. Demonstrates responsibility for fiscal planning and management of the unit-based budget. Engages in ongoing productivity monitoring adherence to prescribed annual budget and assurance of adequate availability of personnel and other necessary resources to support the delivery of safe patient care and realization of departmental goals. Provides clinical leadership through role modeling professional practice behaviors and maintaining role accountabilities at the level of the associates. Integrates ethical standards and SPIRIT values into everyday activities. Supports the achievement of Magnet Recognition or Pathways to Excellence programs as determined by the Entity Chief Nursing Officer and/or Senior Director of Nursing. Serves as a change agent assisting others in understanding the importance necessity impact and process of change. Collaborates with the Senior Nursing Leadership Team to seek and utilize information to develop implement and manage a budget which supports organizational objectives patient care standards safety high reliability and quality of care. Hires evaluates coaches mentors promotes counsels disciplines and when necessary terminates associates to achieve behaviors aligned with MedStar's vision mission and values. Develops associates based on their strengths and professional advancement needs. Utilizes approaches and strategies that support the retention engagement and recruitment of associates; optimize patient care outcomes; and sustain the interdisciplinary model of care (IMOC) and its related standards of excellence. Develops implements and evaluates departmental goals that support the nursing strategic plan in collaboration with the nursing leadership team and other personnel within the department. Delegates certain activities to others within the unit/department as appropriate. Monitors and analyzes departmental performance data (e.g. nursing sensitive measures) and identifies and participates in performance improvement opportunities. Ensures compliance with unit divisional hospital/facility policies and procedures and governmental and accreditation regulations. Takes corrective action when deficiencies occur. Creates and supports a patient-centered care environment that fosters optimal patient experience as demonstrated by outcomes data. Communicates with patients' families and significant others and acts as resource for associates in dealing with patient/family issues. Investigates and follows through on customer complaints and concerns. Ensures that adequate materials supplies and equipment are available in support of optimal care delivery and that cost containment efforts are implemented. Communicates new material and supply needs to materials/supply chain leaders. Participates or engages associates as appropriate in product and equipment selection. Oversees the development of unit specific orientation preceptor programs and competencies for all personnel within the department. Collaborates with nursing professional development practice innovation and informatics and supports the implementation of new programs. Helps design educational and competency assessment programs to ensure the highest quality care delivery and customer engagement. Provides associates with timely constructive feedback on performance. Develops standards of performance evaluates performance of associates and conducts performance management planning. Identifies individual development needs and provides appropriate resources to meet needs. Initiates or makes recommendations for personnel actions. Maintains ongoing communication with associates to review programs provide feedback discuss new developments and exchange information. Engages in unit/department-based activities that enhance cost containment facilitate capacity management and patient flow/throughput and promote efficient care delivery systems. Actively participates in efforts to reduce patient length of stay by collaborating with medical providers and other disciplines to facilitate timely discharge planning. Participates in hospital/entity or system committees task forces interdisciplinary forums and projects (e.g. serious safety event reviews and performance improvement teams) at the request of Senior Nursing Leadership Team. Promotes a public image of professional nursing excellence and represents the hospital in community outreach efforts as appropriate. Maintains knowledge of current trends and developments in the fields of nursing and health care through a variety of professional activities including but not limited to reading the appropriate literature attending related seminars and conferences and maintaining membership in professional nursing associations. Demonstrates accountability for own professional development and advancement. Assumes administrative responsibilities in absence of the Senior Director of Nursing and provides coverage for other colleagues. Maintains the ability to provide direct care for a caseload of patients as required. Minimal Qualifications Education Bachelor's degree in Nursing from a nationally accredited program required Master's degree in Nursing or health related field from a nationally accredited program preferred Experience 3-4 years of nursing experience required 1-2 years of management and leadership experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure In the District of Columbia required CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required Additional unit/specialty certifications may vary by department or business unit. C-EFM - Electronic Fetal Monitoring from the National Certification Corporation (NCC) is required for Perinatal nurses (labor and delivery antepartum antenatal testing) within 12 months from date of hire. New graduate nurses or new to specialty nurses (labor and delivery antepartum antenatal testing) will have 15 months from date of hire to obtain the EFM certification. Specialty certification from a nationally recognized nursing organization in either his/her clinical specialty or Nursing Administration within 2 years required Knowledge Skills and Abilities Excellent problem-solving skills and ability to exercise independent judgment on highly complex situations. Verbal and written communication skills. Basic knowledge of various computer software applications and online learning applications especially Microsoft PowerPoint and Excel. This position has a hiring range of : USD $120,702.00 - USD $238,222.00 /Yr.

RN Director of Nursing Perioperative Services

MedStar Health Northwest Washington, DC

$120,702 - $238,222 / year

About this Job: General Summary of Position MedStar Ambulatory Services is committed to providing world-class compassionate care to every patient every time at every touch point. All associates are accountable for their role in meeting patient experience standards.Responsible and accountable for daily operating and recovery room operations which include clinical and financial management associate education and development and resource management with ultimate goal of achieving quality and safe patient care. Assists with patient care as needed. Acts as a role model and displays leadership in management systems clinical practice and performance improvement in accordance with the philosophy of MedStar Health and MedStar Ambulatory Services (MAS). Collaborates with the Vice President on all clinical and operations matters. Articulates and exhibits customer service focus philosophies. Primary Duties and Responsibilities Assists the Vice President in the preparation and monitoring of departmental budget and establishes methods for control. Works with the Facility and Supply Chain Manager to coordinate availability of supplies and equipment. Promotes economical use of supplies and equipment. Collaborates with physicians/providers and outside agencies to meet the identified needs of the patients and the organization. Communicates effectively and courteously with visitors physicians patients and associates. Monitors patient satisfaction and works with leadership team and staff to implement changes to improve patient satisfaction. Supports a patient-centered care environment and fosters optimal patient experience as demonstrated by outcomes data. Conducts daily morning report for associates and monthly team meetings. Conducts routine staff meetings. Contributes to the achievement of established goals and objectives and adheres to department policies procedures quality standards and safety standards. Completes annual Code of Conduct Compliance and other mandatory training. Complies with governmental and accreditation regulations. Coordinates and discusses personnel issues and or activities with the Vice President as appropriate. Coordinates training and orientation of new personnel and provides relevant current and accessible education resource materials for associates. Leads the development and execution of competency management program for associates in the department. Develops revises implements and interprets policies procedures care standards objectives and goals relative to MAS. Stays abreast of industry trends and implements changes as needed. Communicates changes in MAS philosophy goals procedures plans and activities to staff in a timely manner. Ensures compliance with unit divisional hospital/facility policies and procedures and governmental and accreditation regulations. Takes corrective action when deficiencies occur. Monitors job performance of associates as demonstrated by current performance reviews within the established time frame. Initiates coaching counseling and corrective action in a timely and supportive manner using the Spirit values as a guide. Participates in meetings and on committees and represents the department and center in community outreach efforts. Active participant in Emergency Preparedness Command Team and Culture of Safety Committee. Participates in multi-disciplinary quality and service improvement teams. Develops infection control and SPD protocols and monitors compliance. Provides opportunity for the associates to participate in continuing education programs to meet personal professional and MAS related goals. Ensures SiTEL mandatories are completed by associates. Supervises nursing practice ensuring that professional nursing standards are met. Maintains proper mix of staff to provide safe efficient patient care. Participates in the recruitment and interviews of potential staff based on MAS needs. Evaluates positions (retain or dismiss). Provides daily assignments and utilization of Low Census Days. Holds associates for their actions develops action plans and corrective actions when appropriate. Updates MAS Quality Improvement Program annually. Monitors aspects of care and initiates changes in areas of deficiency. Prepares Quality Improvement reports and submits through defined channels. Serves as a change agent assisting others in understanding the importance necessity impact and process of change. Maintains knowledge of current trends and developments in the fields of nursing and health care through a variety of professional activities including but not limited to reading the appropriate literature attending related seminars and conferences and maintaining membership in professional nursing associations. Demonstrates accountability for own professional development and advancement. Minimal Qualifications Education Bachelor's degree of Nursing from a nationally accredited program. required and Master's degree in Nursing or a relevant field preferred Experience 5-7 years of progressive Perioperative Nursing experience and an Ambulatory Surgery Center environment required and 1-2 years 2 years of management/leadership experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure Valid RN license in Maryland District of Columbia (DC) or Virginia or any combination as required based on work location(s). Upon Hire required and CPR - Cardiac Pulmonary Resuscitation (includes BLS and NRP) for healthcare providers from either the American Heart Association (AHA) or American Red Cross within 90 Days required and Additional unit/specialty certifications may vary by department or business unit. Knowledge Skills and Abilities Demonstrated competence in professional nursing practice including teaching leadership and management skills. Ability to focus on customer service. Ability to work independently and possess the ability to make appropriate decisions regarding patient care employee relations or other management issues based on policies and standards of practice. Excellent verbal and written communication skills. Ability to communicate effectively with all levels of personnel physician's patients and family in support of a collaborative environment. Basic computer skills preferred. This position has a hiring range of : USD $120,702.00 - USD $238,222.00 /Yr.