Acute Care, Budgeting, Business Case, Business Performance Management, Business Support, Case Management, Certified Case Manager (CCM), Communication Skills, Computer Skills, E Programming Language, Employee Orientation, Federal Laws and Regulations, Flexible Spending Accounts, Healthcare, Healthcare Providers, Hospital, Hospital Administration, Internal Rate of Return (IRR), Leadership, Life Insurance, Maintain Compliance, Operational Improvement, Organizational Skills, Presentation/Verbal Skills, Problem Solving Skills, Registered Nurse (RN), Regulations, Reimbursement, Resource Utilization, State Laws and Regulations, Time Management, Training/Teaching, Vision Plan, Writing Skills
Overview
Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At John F. Kennedy Memorial 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 John F. Kennedy Memorial 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
Job Summary
Shift: Days
Hours:
Job Type: Full Time
The individual in this position has overall responsibility for hospital utilization performance improvement and operational management of the Case Management Department 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.
Responsibilities
- Maintains an adequate number and skill mix over seven days a week to serve the patient population and meet the goals of the department
- Implements and supports with business case staffing requests utilizing the Tenet Case Management staffing recommendations and hospital budgetary guidelines
- Holds regular departmental meetings with staff to provide updates and provides for ongoing education
- Completes initial and annual competency and evaluation review on all case management staff
- Follows the InterQual Inter-rater Reliability (IRR) Policy to determine initial and yearly competency for all employees performing InterQual reviews
- Develops action plan for case managers that fail to meet the IRR acceptable 'match' rate to ensure improvement in the accurate application of InterQual criteria
- Ensures new case management staff complete department orientation including review of Tenet Case Management and Compliance policies and Allscripts training.
- Monitors case management processes and staff productivity to ensure medical necessity reviews are completed timely and accurately, payer communications are sent and authorizations or denials documented and followed up, and that transition planning assessments are completed timely.
Qualifications
Required:
- Active Registered Nurse License
- At least two (2) years acute hospital case management leadership experience
- Demonstrated organizational skills
- Excellent Verbal and written communication skills
- Ability to lead and coordinate activities of a diverse group of people in a fast paced environment
- Critical thinking and problem solving skills and computer literacy.
Preferred:
- MSN
- Accredited Case Manger (ACM)
- McKesson InterQual experience
- Five (5) years acute hospital case management experience
Organization Description
Desert Care Network serves the healthcare needs of the Coachella Valley and Morongo Basin regions in Southern California with three hospitals Desert Regional Medical Center in Palm Springs, JFK Memorial Hospital in Indio and Hi-Desert Medical Center in Joshua Tree. The hospital network provides advanced care with services such as comprehensive stroke care, a cancer center, a Level 1 Trauma Center and the only Level 3 Neonatal Intensive Care Unit (NICU) in the Coachella Valley. Desert Care Network is committed to healthcare equality. Join our team!
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.
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E-Verify: http://www.uscis.gov/e-verify
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Tenet Healthcare Corp
Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.
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