Govt Audit Programs Director

NEWLY CREATED POSITION at Saint Thomas Health Services for a GOVERNMENT AUDIT PROGRAM DIRECTOR

Job Summary:  Reporting to the STHS Corporate Responsibility Officer, the Director is the main contact for governmental audits (such as RAC, MIP, ZPICS) and acts as the hospital liaison for all related concerns and actions.  The Director is responsible for interacting on a professional basis with members of the medical staff, administration, management, patient care services, ancillary departments, as well as agency contacts and Executive Health Resources staff.

Job Responsibilities (in part):  Receive all communication from governmental agencies and initiate recovery audit response process. Update and maintain the audit tracking database.   Continually monitor the status of audit requests and identify areas for improvement in the response process, report findings or recommendations to senior management.  Establish and maintain responsive and cooperative relationships with medical staff.  Provide monthly reports to STHS Corporate Responsibility Officer related to agency activity and identified patterns and trends.  Actively participate in the development and implementation of strategies to improve performance/resource management.  Participate in departmental process improvement initiatives, work on special projects as needed and attend all departmental meetings.

Education:  Bachelor's degree is required.

Licensure:  Case Management certification preferred.  RN with current Tennessee licensure is required.

Required Experience:  A minimum of 4 years experience in case management/utilization management in hospital or managed care environment.  Clinical expertise and experience in clinical areas.  Must have knowledge of Medicare and Medicaid coverage and reimbursement rules and ability to recognize compliance risks.  Knowledge of screening criteria systems such as InterQual.  Knowledge of quality improvement principles and techniques.  Experience with quality management systems such as Midas is desirable.

This position is a system position (for our 4 hospitals).  Office will be located at Saint Thomas Hospital.  ~cb~