SUMMARY:
The individual in this position support the Director of Clinical Quality Improvement in the hospital utilization performance improvement and Case Managers tasks. 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.

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
� Education provided to physicians, patients, families and caregivers

The individual's responsibilities include the following activities: a) support case managers in workload as needed to assure effective and timely throughput and reimbursement for services provided, b) supports DCQI in the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement,
c) ensure medical necessity review processes are completed accurately and in compliance with CMS regulations and Tenet policy, d) ensure timely and effective patient transition and planning to support efficient patient throughput, e) implement and monitor processes to prevent payer disputes, f) collaborates with physicians, office staff, and ancillary department, g) ensure compliance with state and federal regulations and TJC accreditation standards. i) assist DCQI with onboarding of new employees and education of staff, j) will assist Case Managers in performing tasks when workload warrants it, and k) other duties as assigned.

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QUALIFICATIONS:
Required qualifications include an active Registered Nurse license with at least two years acute care Case Management Experience. Accredited Case Manager (ACM) preferred. McKesson InterQual� experience preferred.. Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy.

PHYSICAL DEMANDS:
While performing the duties of this job, the employee is regularly required to sit, talk, and hear. The employee is frequently required to use fine motor skill (typing/data entry), and reach with hands and arms. The employee is frequently required to stand; walk; and occasionally stoop, kneel, or crawl. The employee must regularly lift and /or move up to 20 pounds and occasionally lift and/or move up to 50 pounds.

Employment practices will not be influenced or affected by an applicant�s or employee�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.