Job Description
Responsible for hospital utilization performance improvement and operational management of the Case Management Department in order to promote effective utilization of hospital resources, ensure processes support appropriate reimbursement for services rendered, support efficient patient throughput, and ensure 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, patient, families and caregivers. Completes established competencies for the position within designated introductory period. Other related duties as assigned.
POSITION QUALIFICATIONS MINIMUM EDUCATION: Master's Degree from an accredited school, college or university as a Social Worker
PREFERRED EDUCATION: MINIMUM EXPERIENCE: 2 years in acute hospital case management, leadership experience
REQUIRED CERTIFICATIONS/LICENSURE: Possession of current Texas State registration as a Social Worker Licensed Certified Social Worker (LCSW) or Licensed Master Social Worker (LMSW)
PREFERRED CERTIFICATIONS/LICENSURE: Accredited Case Management (ACM)
REQUIRED COURSES/ COMPLETIONS (e.g., CPR): None.
Responsibilities
The individual's responsibilities include the following activities:
a) manage department operations to assure effective throughput and reimbursement for services provided,
b) lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
c) ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy,
d) ensure timely and effective patient transition and planning to support efficient patient throughput,
e) implement and monitor processes to prevent payer disputes,
f) develop and provide physician education and feedback on hospital utilization,
g) participate in management of post-acute provider network,
h) ensure compliance with state and federal regulations and TJC accreditation standards and
i) other duties as assigned.
Qualifications
Education:
Required: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
Preferred: MSN, MBA, MSW, or MHA
Experience:
Required: 3 years of acute hospital case management or healthcare leadership experience
Preferred: 5 years of acute hospital case management leadership multi-site experience
Certifications:
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
Physical Demands:
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.
About Us
Who We Are
We are a community built on care. Our caregivers and supporting staff extend compassion to those in need, helping to improve the health and well-being of those we serve, and provide comfort and healing. Your community is our community.
Our Story
We started out as a small operation in California. In May 1969, we acquired four hospitals, some additional care facilities and real estate for the future development of hospitals. Over the years, we've grown tremendously in size, scope and capability, building a home in new markets over time, and curating those homes to provide a compassionate environment for those entrusting us with their care.
We have a rich history at Tenet. There are so many stories of compassionate care; so many "firsts" in terms of medical innovation; so many examples of enhancing healthcare delivery and shaping a business that is truly centered around patients and community need. Tenet and our predecessors have enabled us to touch many different elements of healthcare and make a difference in the lives of others.
Our Impact Today
Today, we are leading health system and services platform that continues to evolve in lockstep with community need. Tenet's operations include three businesses - our hospitals and physicians, USPI and Conifer Health Solutions.
Our impact spreads far and deep with 65 hospitals and approximately 510 outpatient centers and additional sites of care. We are differentiated by our top notch medical specialists and service lines that are tailored within each community we serve. The work Conifer is doing will help provide the foundation for better health for clients across the country, through the delivery of healthcare-focused revenue cycle management and value-based care solutions.
Together as an enterprise, we work to save lives and can accept nothing less than excellence from ourselves in service of our patients and their families, every day.
About the Team
Careers at Tenet
At Tenet Healthcare, the heart of what we do centers on caring with compassion, which ultimately creates a bond between our caregivers and patients. Everyone contributes to these moments, whether providing care directly or supporting those who do.
As an organization, we provide employees with resources, tools and support to serve our patients and customers in the best way possible. We also take care of one another, helping team members further develop their career pathways and maximize their potential.