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.
Responsibilities
- Manage department operations to assure effective throughput and reimbursement for services provided
- Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
- 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
- develop and provide physician education and feedback on hospital utilization
- other duties as assigned.
Qualifications
- Required:
- Education: Bachelor's degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW
- Experience: 3 years of acute hospital case management or healthcare leadership experience
- Licensure/Certification:
- 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:
- Experience: 5 years of acute hospital case management leadership multi-site experience
- Education: MSN, MBA, MSW, or MHA
- Licensure/Certification: Accredited Case Manager (ACM)
About Company
Saint Francis Hospital-Memphis is a 479-bed full-service hospital located at 5959 Park Avenue in Memphis, TN.Offering a wide array of medical services, Saint Francis is noted for its many Centers of Excellence, including its Center for Surgical Weight Loss, Joint & Spine Center, Heart & Vascular Center, Chest Pain Emergency Center, and Surgical Services including its Center for Robotic Surgery, Diabetes Center, and Cancer Center.The hospital has been recognized for excellence of care by United Healthcare, CIGNA, Blue Cross/Blue Shield, and Aetna. Saint Francis Hospital serves as an academic training site for University of Tennessee Surgical, Family Practice, and Psychiatric Residents. The hospital is accredited by the Joint Commission on the Accreditation of Healthcare Organizations, the nations oldest and largest hospital accreditation agency. At Saint Francis Healthcare, you can grow your career skills and be a vital member of our team where we strive to be No. 1 in quality, safety and service excellence. Join our team!
Company
Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At Saint Francis Hospital hospital, were seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success.
At Saint Francis Hospital, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:
- Medical, dental, vision, and life insurance
- 401(k) retirement savings plan with employer match
- Generous paid time off
- Career development and continuing education opportunities
- Health savings accounts, healthcare & dependent flexible spending accounts
- Employee Assistance program, Employee discount program
- Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance
Note: Eligibility for benefits may vary by location and is determined by employment status