With a Level II Trauma Emergency Department, advanced robotic surgery technologies and a focus on compassionate care, Sinai-Grace draws on the history o fthree community hosptials and has served Northwest Detroit for more than 130 years.
Oversees hospital utilization performance improvement and operational management of the site 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.
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
Responsibilities include the following activities: a) manages department operations to assure effective throughput and reimbursement for services provided, b) leads the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement, c) ensures medical necessity review processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensures timely and effective patient transition and planning to support efficient patient throughput, e) implements and monitors processes to prevent payer disputes, f) develops and provides physician education and feedback on hospital utilization, g) ensures compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.
Graduate from an accredited school of Nursing. Bachelorâ��s degree in Nursing or other health-related field, or the equivalent combination of education and/or related experience. Masterâ��s degree in Nursing, Business Administration or Hospital Administration preferred.
Licensed to practice as a Registered Nurse in the State of Michigan;
Three to five years of acute hospital case management leadership experience. Five years acute hospital case management experience preferred. McKesson InterQualâ® experience preferred. Business planning experience preferred.
Accredited Case Manager (ACM) preferred.
Job: Case Management/Home Health
Primary Location: Detroit, Michigan
Facility: DMC Sinai-Grace Hospital
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: 2105018698
About DMC Sinai-Grace Hospital
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.