Director Case Management DMC Adult Central Campus (Detroit Receiving and Harper University Hospitals)
DMC Receiving Hospital
Location: Detroit, Michigan
Internal Number: 2105028747
DMC Detroit Receiving Hospital, Michiganâ��s first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the stateâ��s leading 24/7 hyperbaric oxygen program, Metro Detroitâ��s first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence.
DMC ADULT CENTRAL CAMPUS (Detroit Receiving and Harper University Hospitals)
Adult Central Campus is a dynamic entity within the Detroit Medical Center, comprised of:
â�¢ Harper University Hospital - One of the most technologically advanced hospitals in the nation with fully implemented Electronic Medical Records, 100% medication scanning and advanced robotic surgery technology.
â�¢ DMC Hutzel Women's Hospital - Michigan's first and only hospital for women, serving as the destination for worm's care since 1868 and ranked on the US News & World Report "America's Best Hospitals" list.
â�¢ DMC Detroit Receiving Hospital - Michigan's first Level 1 Trauma Center and one of the busiest and most well-equipped emergency departments, this hospital trains nearly half of the practicing emergency medicine physicians in the state.
Oversees hospital utilization performance improvement and operational management of the site Case Management Departments 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:
â�¢ Utilization Management supporting medical necessity and denial prevention
â�¢ Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
â�¢ Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
â�¢ Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
â�¢ 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.
1. 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.
2. Licensed to practice as a Registered Nurse in the State of Michigan;
3. 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.
4. Accredited Case Manager (ACM) preferred.
Job: Managers and Directors
Primary Location: Detroit, Michigan
Facility: DMC Receiving 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.
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.