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JOB DESCRIPTION:
Under the direction of the VP of Case Management & Continuing Care, the Sr. Director of Utilization Review (UR) is responsible for overseeing the development, implementation, and performance management of Utilization Review services performed across the Tenet enterprise. Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market or region to promote an appropriate level of care and prevent payer denials. Develops structure and processes to optimize staffing and productivity. Leads evaluation and implementation of tools to leverage technology to enable program accuracy and effectiveness. Serves as the Tenet leads with Tenet National Director Clinical Denials, Sr. Director Revenue Cycle, hospital CFOs, Directors Revenue Analysis (DRAs), and Managed Care Contracting to design concurrent processes to secure authorizations and prevent clinical denials. Serves as a member of the Case Management and Continuing Care leadership team to improve Tenet hospital patient care performance as measured by key indicators including level of care, length of stay, patient throughput and compliance metrics. Directly reporting to this position are the market or regional centralized UR Team Manager and/or Director positions.
Leads continuous improvement initiatives and best practice strategies across all Tenet and USPI hospitals to achieve organizational goals through standardized systems and processes.This position will partner with the market and hospital Administrative leaders to ensure the strategies are executed at the local level. He/She will work directly with Tenet, Conifer, and USPI leaders to develop market strategies and tactics that align with company goals. This leadership position builds strong performance-based relationships, manages through roadblocks and barriers to success, and builds processes and protocols to ensure the continued sustainability of initiatives and business processes
Key focus areas:
Uses lean tools to address performance barriers. Develops and implements best practices to achieve organizational goals through effectively leading and managing change in a matrix environment. Oversees the implementation of action plans and monitors progress toward goals assisting with addressing barriers and challenges and making adjustments as needed in a supportive, synergistic manner. Collaborates with medical and nursing leadership, as well as case management and continuing care team members to develop and implement methods to optimize use of hospital and post-acute services.
Manages multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance. May assist with the designing of and providing input needed for implementation and optimization of documentation systems (Cerner, PBAR, CarePort, MIDAS, etc.) to promote data integration, improve workflow and achieve key performance indicators. Fosters an environment that promotes team member support, partnership, growth and development by assessing the needs of the team and implementing programs to meet those needs. Provides analysis and education regarding regulatory and clinical changes impacting inpatient and post-acute care processes and reimbursement. Provides education and tools for educating physicians and staff regarding programs and processes. Works in alignment with hospital and Conifer leadership teams and consistently demonstrates ability to:
REQUIRED SKILLS:
Benefits
The following benefits are available, subject to employment status:
Up to 50% travel.
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
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2403019830Other
$118k-154k (estimate)
06/13/2024
08/12/2024