The individual in this position has overall responsibility for operational management of the Case Management Department; including staffing, budgets and plans.
The individual’s responsibilities will include, but not be limited to the following activities:a) Complying with relevant Tenet policies including Case Management and Clinical Determination Policies b) implementing and revising the UM Plan and promoting cooperation with utilization review standards by the medical staff c) Maintaining / facilitating communication between the case management department and the physician advisor on a regular basis regarding utilization review and/or quality issues d) Maintaining / facilitating communication between the case management department and the physicians as well as other members of the healthcare team e) analysis of reports: LOS, avoidable days, disputes, InterQual and associated metrics f) Responsible for implementation and compliance with all policies and regulations relating to the functioning of the case management department g) and all other duties as assigned.
Required qualification should include extensive management and clinical experience. A Registered Nurse with a BSN, management experience and at least 3 years of experience as a case manager is preferred.
Directors hired prior to August 2009 are grandfathered in with the same performance expectations.Required Licenses/Certifications
BSN, MSN preferred
Required Skills, Knowledge, and Abilities
· Patient data
· Healthcare staff documentation related to patient care
· Regulatory and payer requirements
· Budgetary and operations data
· eCCM: Clinical data interface, InterQual, Case Management documentation,
secure faxing, Avoidable Day tracking
· Patient Medical Record and HPF
· Hospital specific Clinical Software
· Enterprise Reporting: Decision Support reports, PMI reports
· Care Discovery
· Position Control/payroll
Job : Case Management/Home Health
Primary Location : TX-El Paso
Hospital/Facility : 168-Sierra Medical Center - El Paso, TX
Job Type : Full-time
Shift Type : Days