As the largest hospital in San Luis Obispo County, Sierra Vista Regional Medical Center strives to produce optimal outcomes and exceptional patient experiences to the community it serves. With 164 beds and hundreds of physicians, Sierra Vista puts advanced technology into the hands of experienced medical specialists to deliver quality healthcare to Central Coast residents and visitors. Its distinct, high-level services include neurosurgery, orthopedics, obstetrics, perinatology (high-risk pregnancy), neonatology (high-risk newborn care), pediatrics and trauma. Sierra Vista houses the largest Level III Neonatal Intensive Care Unit between Santa Barbara and Salinas, the only dedicated pediatric unit in San Luis Obispo County and serves as the county�s designated trauma center. Sierra Vista is recognized as a leader in orthopedics, cancer care and is a Joint Commission accredited primary stroke center. Sierra Vista is fully accredited by The Joint Commission and has been serving the community since 1959.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
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. 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) manage department operations to assure effective throughput and reimbursement for services provided, b) lead 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) develop and provide physician education and feedback on hospital utilization, , g) ensure compliance with state and federal regulations and TJC accreditation standards, and h) other duties as assigned.
Required qualifications include an active Registered Nurse license with at least two years acute hospital case management leadership experience. BSN required. MSN preferred. Accredited Case Manager (ACM) preferred. McKesson InterQual� experience preferred. Five years acute hospital case management experience preferred. Required skills include 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. Business planning experience preferred.
Job: Case Management/Home Health
Primary Location: San Luis Obispo, California
Facility: Sierra Vista Regional Medical Center
Job Type: Full-time
Shift Type: Days
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.
Internal Number: 1905023254
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