Director of Case Management, Revenue Integrity

Job not on LinkedIn

🔥 0 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 10%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Quorum Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2016

🏥 Healthcare

👥 B2C

Healthcare • B2C

Quorum Health is an operator of general acute care hospitals that owns or operates 12 hospitals across nine U. S. states. The company partners with local providers and subsidiaries to deliver inpatient and community-based healthcare services, focusing on quality, safety, and supporting local economies and workforce development. Quorum Health emphasizes community investment, hospital administration, and empowering local teams to provide patient-centered care.

📋 Description

• Direct and manage the corporate Case Management program across assigned facilities • Establish strategy, policies, standardized workflows, education, competency expectations, performance monitoring, and operational support • Ensure compliant, patient-centered discharge planning and timely transitions of care • Analyze and escalate complex discharge barriers, avoidable delays, readmissions, and care-transition concerns • Collaborate with Utilization Review leadership while maintaining separation from UR ownership and determinations • Design, implement, and maintain the enterprise Revenue Integrity program • Develop and execute risk-based audits of charge capture, billing, claim edits, revenue codes, modifiers, units, duplicate or missing charges, and related risk areas • Direct audits and validate billed services against health records, documentation, payer requirements, policy, and billing guidance • Partner with Coding, CDI, HIM, Patient Financial Services, Finance, clinical departments, IT, and Compliance on corrective actions • Establish governance for charge-capture and chargemaster-related integrity activities • Identify, quantify, trend, and escalate overpayments, underpayments, duplicate billing, unsupported charges, and compliance concerns • Maintain objective audit workpapers, sampling methodology, findings, financial impact, corrective actions, owners, deadlines, and validation results • Develop dashboards and report Case Management and Revenue Integrity performance, risks, financial impact, barriers, and program value • Monitor regulatory, payer, CMS, OIG, privacy, and information-security requirements • Select, develop, evaluate, coach, and manage assigned staff • Manage strategic goals, budget recommendations, vendor relationships, productivity expectations, and resource needs • Represent the functions on multidisciplinary committees, leadership meetings, and work groups

🎯 Requirements

• Bachelor's degree in Nursing, Social Work, Health Information Management, Healthcare Administration, Business, Revenue Cycle, or a closely related field required • Minimum of seven (7) years of progressive acute-care hospital experience in Case Management, Revenue Integrity, Revenue Cycle, HIM/Coding, Compliance, Clinical Operations, or a closely related field required • At least three (3) years of leadership, management, audit, education, or multi-facility program oversight • Demonstrated experience conducting revenue integrity or billing-compliance audits and implementing corrective actions required • Advanced knowledge of acute-care discharge planning, care coordination, transitions of care, complex case escalation, post-acute placement, patient choice, and readmission/avoidable-delay analysis • Advanced knowledge of hospital charge capture, chargemaster concepts, revenue codes, modifiers, claim edits, inpatient and outpatient billing workflows, and reimbursement methodologies • Working knowledge of CMS Hospital Conditions of Participation, Medicare and Medicaid requirements, HIPAA, fraud/waste/abuse principles, overpayment obligations, payer requirements, and applicable state requirements • Ability to design risk-based audit plans, define samples and criteria, document reproducible findings, quantify financial impact, identify root cause, and validate corrective action • Advanced ability to collect, analyze, trend, and present operational, clinical, financial, and audit data • Demonstrated ability to build programs, teams, policies, tools, metrics, and governance structures • Proficiency with Microsoft Office applications • Experience with electronic medical records, case management systems, hospital patient-accounting/billing systems, claim-scrubber/edit tools, and data analytics or audit software • Must be able to travel nationally as needed • Current unrestricted RN, social work, or other applicable professional license required only when assigned duties constitute licensed practice

🏖️ Benefits

• Competitive salary and benefits package • Opportunities for professional development and advancement • Supportive work environment with a collaborative team • Comprehensive healthcare coverage • Retirement savings plan • Paid time off and flexible scheduling options • Student loan repayment program