• Job Description

  Req#: 2403004221

  Saint Vincent Hospital offers a whole new experience in health care. By combining our advanced, state-of-the-art facility with our commitment to providing the best quality of life to the many members of our Worcester community. Saint Vincent Hospital excels at offering the best care in a friendly atmosphere. From our advanced heart and vascular services, to our comprehensive orthopedics and rehabilitation programs, our robust surgical facility including our Da Vinci robotic surgery and Cyberknife technology, to our comfortable and compassionate women & infants programs - you don't have to travel far for high-quality health care: We're right here, in the heart of Worcester.
  
  
  Onboarding Process: Please be advised that candidates must successfully complete a background check and pre-employment health screening which includes a drug screen.

  
  Position Summary:
  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; and Education provided to physicians, patients, families, and caregivers

  Job 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.

  
  #LI-MD2

  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 an 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.

  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.

  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.

• About the company

  Tenet Healthcare Corporation is a multinational investor-owned healthcare services company based in Dallas, Texas, United States.

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