Description
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The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women's Hospital, the DMC Heart Hospital, Huron Valley-Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital.
DMC's 150-year legacy of medical excellence and service provides patients and families world-class care in cardiovascular health, women's services, neurosciences, stroke treatment, orthopedics, pediatrics, rehabilitation, organ transplant and other general and specialty services.
DMC is a key partner in Detroit's resurgence, which continues to draw national and international attention. A dedicated corporate citizen with strong community ties, DMC is one of the largest and most diverse employers in Southeast Michigan.
Summary Description The Group Director, Case Management will perform the functions necessary to support and advance Tenet’s Case Management strategy. Will support the advancement of Case Management as a leader, mentor, and consultant. Will execute on the strategic plan and will provide subject matter expertise for Case Management regulations and standards, including ensuring compliance with all state and federal regulations. Will ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput. Includes integration of 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. Further, includes care coordination by demonstrating throughput efficiency while assuring care is the right sequence and of the appropriate level. Will serve as an information resource, and will work in collaboration with physicians, allied health professional administrators, corporate, finance department staff, supply chain staff, vendors, and individual internal and external to the Detroit Medical Center.
Essential/Primary Duties: • Lead and facilitate group hospital Directors of Case Management performance for Level of Care, Length of Stay, and Payer Authorizations
• Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy
• Lead Group hospital Case Management and Utilization Review operations for cost-effective and clinically sound care delivery including the Tenet Case Management model, staffing and skill mix, complex Case Management, and centralized utilization review
• Participate in new hospital Director of Case Management selection and lead the orientation and onboarding processes
• Maintain objectivity in decision making, utilizes facts to support decisions
• Anticipate and responds to problems and risks
• Communicate effectively with all levels in the organization and with internal / external customers
• Direct, support, and coach direct reports
• Develop “experts” and “expertise” throughout the department and seeks employee input
• Minimize staff turnover
• Lead implementation and monitoring of Tenet Case Management policy and regulatory requirements
• Review weekly Case Management Scorecard Continuing Care (CC) and Utilization Review (UR) metrics, Observed / Expected Length of Stay, Authorizations and Downgrades
• Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
• Manage department operations to ensure effective throughput and reimbursement for services provided
• Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
• Ensure timely and effective patient transition and planning to support efficient patient throughput
• Implement and monitor processes to prevent payer disputes
• Develop and provide physician education and feedback on hospital utilization
• Participate in management of post-acute provider network
• Ensure compliance with state and federal regulations and The Joint Commission accreditation standards
• Use strong communication skills, oral and written, to effectively convey new programs, policies, and processes needed to affect change successfully
• Maintain safe environment
• Participate in Performance Improvement activities
Qualifications
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Minimum Qualifications 1. Bachelor’s degree in business, nursing or health care administration required. Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred
2. A minimum of 5 years of experience in hospital revenue cycle function. Five (5) years in hospital Case Management Leadership required. Multi-site hospital case management leadership experience preferred. Business planning and project management experience preferred.
3. Registered Nurse or LCSW/LMSW license; or relevant experience as approved by VP of Case Management required. Accredited Case Manager ACM) preferred.
Skills Required 1. Analytical ability to serve in an advisory/consultative role in determining and/
