The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patientï¿½s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis. This position integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
Accurate medical necessity screening and submission for Physician Advisor review
Securing and documenting authorization for services from payers
Managing concurrent disputes
Collaborating with payers, physicians, office staff and ancillary departments
Timely, complete and concise documentation in the Tenet Case Management documentation system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting over and underutilization
Required: Two (2) years hospital acute or behavioral health patient care experience. Preferred: One (1) year hospital acute or behavioral health case management.
Required: Active and valid RN license. Preferred: Accredited Case Manager (ACM).
Primary Location: Birmingham, Alabama
Facility: Brookwood Medical Center
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: 1905038716
About Brookwood Baptist Medical Center
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.