The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services. This position integrates national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to physicians, patients, families and caregivers
The individualï¿½s responsibilities include the following activities:
Manage department operations to assure effective throughput and reimbursement for services provided
Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
Ensure timely and effective patient transition and planning to support efficient patient throughput
Implement and monitor processes to prevent payer disputes
Develop and provide physician education and feedback on hospital utilization
Participate in management of post-acute provider network
Ensure compliance with state and federal regulations and TJC accreditation standards, andi) other duties as assigned.
Required: Bachelorâ��s Degree in Business, Nursing, Social Work or Health Care Administration or relevant experience as approved by VP of Case Management
Preferred: MSN, MBA, MSW or MHA preferred
Required: Two (2) years in Case Management Leadership
Preferred: Five (5) years acute hospital case management experience preferred. Business planning experience preferred. McKesson InterQualâ® experience preferred.
Required: Registered Nurse or LCSW/LMSW license; or relevant experience as approved by VP of Case Management
Preferred: Accredited Case Manager (ACM)
Lift/position up to 25 lbs. Push/pull up to 25 lbs of force.
Frequent sitting. Moderate standing, walking, reaching, stooping, and bending
Manual dexterity, mobility, touch, auditory to perform all the related duties of the position
Job: Managers and Directors
Primary Location: Brownsville, Texas
Facility: Valley Baptist Medical Center - Brownsville
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��s race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. Tenet will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship.
Internal Number: 2105015430
About Valley Baptist Medical Center - Brownsville
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.