Carondelet Health Network is committed to providing Southern Arizonans with a full spectrum of high-quality, cost-efficient health care. Our top priority is improving the health of all those we serve, and has been serving and caring for the Tucson and Southern Arizona community for over 130 years. We invite you to share in this commitment. No matter what position you seek, your experience, skills and compassion are greatly valued. We count on the strengths of each individual to bring our mission of care to the patients and families of Southern Arizona.
Established in 1961, St. Josephï¿½s Hospital is a premiere medical campus serving Tucson and the Southwest. St. Josephï¿½s is home to the Carondelet Neurological Institute and the Carondelet Joint Replacement Center. The 486-bed facility is an accredited Chest Pain Center, has been recognized by the American Heart and Stroke Association with a Get with the Guidelines Award for stroke care, and has nationally-certified Cardiac and Pulmonary Rehabilitation Programs. Here youï¿½ll find one of the regionï¿½s most comfortable labor and delivery units as well as high-quality care and customer service in programs such as cardiology, orthopedics, oncology, wound care, stroke, diabetes, emergency medicine and rehabilitation.
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 Education provided to physicians, patients, families and caregivers
The individualï¿½s responsibilities include the following activities:
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
Implement and monitor processes to prevent payer disputes
Develop and provide physician education and feedback on hospital utilization
Participate in management of post-acute provider network
Ensure compliance with state and federal regulations and TJC accreditation standards, and other duties as assigned.
MINIMUM EDUCATION: Bachelor's Degree in Nursing
PREFERRED EDUCATION: MSN.
MINIMUM EXPERIENCE: Five years experience in nursing management in a hospital setting with three years supervisory experience required.
PREFERRED EXPERIENCE: Minimum two years experience as Case Management Director in an acute care hospital
REQUIRED CERTIFICATIONS/LICENSURE: Current Arizona Registered Nurse License.
SPECIAL SKILLS: Must be able to utilize independent decision-making skills in a wide variety of situations. Requires a high degree of accuracy in the performance of varied responsibilities. Personal computer skills required. Frequent contact with employees, physicians, customers, community individuals and volunteers. Must be self-motivated to complete work in a timely manner to meet deadlines. Computer skills required.
SUPERVISES: Nursing staff.
Job: Managers and Directors
Primary Location: Tucson, Arizona
Facility: Carondelet St. Joseph's Hospital
Job Type: Full-time
Shift Type: Days
Employment practices will not be influenced or affected by an applicantâ��s or employeeâ��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.
Internal Number: 2005028677
About Carondelet St. Joseph's Hospital
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.