Hospital/Facility: Tenet Healthcare
Location: Dallas, TX
Tenet’s Performance Management and Innovation (PMI) Department is an internal consulting group within Tenet that is focused on improving cost efficiency and patient throughput throughout Tenet. The PMI team is comprised of experts in Nursing, Perioperative, ED, Imaging, Case Management, Labor Productivity, and both Clinical and Financial Analysts.
The PMI team works collaboratively with Tenet Hospitals to ensure implementation and benefit realization from the Medicare Performance Initiative (MPI) and other Performance Management and Innovation (PMI) engagements with respect to sustainability and repeatability of the Medicare Performance Initiative (MPI) including: (a) tracking, monitoring and assisting as needed with sustainability of Wave 1 MS-DRGs after the initial PMI rollout team transitions out; (b) ensuring repeatability and execution of Wave 2 and future Waves of MS-DRGs, including assisting with data access, assisting hospitals and regions with monitoring and tracking of work plans and scorecards, reviewing/setting targets, and on-site support as needed, intervening with hospitals and elevating progress concerns to Region as needed. Team members also monitor and track scorecard performance and implementation progress relative to other PMI engagements, including ED, Imaging and Case Management.
The Senior Director of Case Management for PMI will work with the Senior Case Management Specialists, Director, Case Management Education and Informatics, the Case Management Executive Committee, the Quality Department, and the Compliance Department to develop and execute policies. The Tenet Case Management Program includes, but is not limited to, the execution of policies and standardized processes to improve the clinical determination of patient status, reduce ALOS, maintain governmental compliance, and reduce denials/disputes arising from governmental and managed care payors. The Senior Director of Case Management PMI will work closely with Corporate, Region and Hospital management to achieve and sustain staffing targets for case management activities through the direct management and collaboration with PMI content experts and sharing best practices.
This role requires travel approximately 80-90 percent of the time in working with both hospital and office environments.
An RN with Master’s degree is required, and at least 10 years of leadership and managerial responsibility in hospital case management, multi-hospital responsibility in a healthcare system is highly preferred. Should have demonstrated experience with providing education via classroom, webex, and other mediums and demonstrated experience with reducing length of stay and reducing third party payor payment denials and disputes. Experience working in a case management consulting role would be a plus.
The successful candidate must possess diverse knowledge in clinical, financial and compliance areas, with the ability to incorporate this knowledge into operational performance improvements. Also essential are a solid knowledge base in federal regulations as they relate to utilization review; extensive comprehension of Medicare, Medicaid, and insurance guidelines; solid understanding of reimbursement methodologies; and working knowledge of InterQual for medical necessity and appropriateness of care. Strong analytical and problem solving skills are a must, as are advanced PC skills including Word, Excel, PowerPoint and Outlook.
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