| Position Description: | Current CT RN license, BSN required, MSN preferred. Certification in Case Management or Utilization Review is preferred. 5-7 years of progressive experience in Case Management. Knowledge of Medicare/HCFA regulations, Corporate Compliance and State regulations regarding D/C planning and hospital reimbursement for services. Current knowledge of managed care providers and their precertification, review and appeals processes of provided hospital services. Under the direction of the Vice President of Patient Care Services, plans, organizes and directs all activities of the Department of Continuing Care & Utilization Management. Provides guidance and/or direction in the management of overall discharge planning and appropriate use of hospital resources of neonate, infant, pediatric, adolescent, adult and geriatric patient populations in accordance with Federal and State laws, and hospital policies and standards. Prepares and provides hospital resource utilization data to the Utilization Management Committee, Windham Hospital PHO/SPN and patient accounts. Responsible for yearly departmental budget preparation. Maintains a program of admission and continued stay certification for Medicare, Medicaid and HMO review. |