Group Director - Utilization Review

Tenet • Detroit, MI

20h • Onsite

About The Position

The Group Director, Utilization Review will perform the functions necessary to support and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of Centralized Utilization Review as a leader, mentor, and consultant. Will execute on strategic initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations.

Requirements

• Bachelor’s degree in business, nursing or health care administration required.
• A minimum of 5 years’ experience in hospital revenue cycle function.
• Five (5) years in hospital Utilization Review Leadership preferred.
• Multi-site leadership experience preferred.
• Experience successfully implementing centralized Utilization Review teams for multi-hospital system strongly preferred.
• Working knowledge of CarePort and MIDAS documentation and reporting required.
• Project Management and Business Planning experience.
• Strong analytical skills including use of Tableau and Excel.
• Executive communication and presentation skills including ability to use PowerPoint.
• Valid Registered Nurse (RN) preferred

Nice To Haves

• Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred.
• Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred.
• Six Sigma Green Belt preferred

Responsibilities

• Developing and maintaining procedure manuals for such activities as UM annual work plan/evaluation and quarterly and semi-annual UM reports.
• Oversight of daily operations of the UM team and optimizing denial mitigation processes.
• Partnering with the Group DCM and Hospital Case Mgt. Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.
• Ensuring effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput.
• Integrating national standards for utilization management supporting medical necessity and denials prevention.

Benefits

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off (PTO)
• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager