Under the direction of the Vice President of Case Management, the USPI Director of Case Management is responsible for supporting case management services within the USPI surgical hospitals in all markets. This position is responsible for leading USPI case management functions. The person in this role will develop and implement relevant education, ensure consistent and standard processes and workflows across all surgical hospitals related to case management and utilization review and partner on strategies related to readmission prevention. Serves as a member of Case Management leadership team responsible for Level of Care, Length of Stay and Clinical Denial Prevention performance for USPI surgical hospitals. Leads continuous improvement initiatives and case management revenue cycle and patient throughput best practice strategies in the assigned hospitals to achieve organizational goals through standardized processes.

Works in alignment with USPI Clinical Services and consistently demonstrates ability to:

Case Management Integration & Standardization:

• Overseeing the integration of national standards into case management processes.
• Standardizing processes and workflows across sites, including discharge planning, case management, utilization review, and reporting dashboards.
• Coordinating with the sites to ensure appropriate staffing of case management teams in all hospitals, addressing gaps, and overseeing recruitment or temporary coverage as needed.
• Identifying and implementing best practices for discharge planning, reducing length of stay, and optimizing level of care.
• Supporting utilization management and working with the Sr. Director of Utilization Review, to ensure medical necessity, appropriate levels of care, and preventing denials.
• Ensuring compliance with federal and state regulations, as well as accreditation standards (e.g., TJC).

Education & Training:

• Onboarding new Case Managers and ensuring consistent training practices.
• Leading educational initiatives for Case Managers to improve patient experience.
• Providing analysis and education on changes in regulations or clinical practices that affect hospital operations and reimbursement.

Process Improvement & Implementation:

• Oversee the collection and analysis of data related to length of stay, case management performance, discharge planning efficiency, and clinical denials across the hospitals to identify performance improvement opportunities
• Develop, implement, and track key performance indicators (KPIs) for case management teams, ensuring targets are met.
• Monitoring and improving efforts to reduce patient readmissions.
• Overseeing action plan development and monitoring progress toward KPIs, goals, addressing barriers, and adjusting as necessary

Service Culture & Patient Experience:

• Promoting a strong service culture that enhances patient experience across the continuum of care.
• Building and maintaining relationships with hospital and market leaders.

Other Duties:

• Performing any additional tasks as needed.

Key focus on leading and supporting case management staff and services within the USPI surgical hospitals in all markets. This leadership position builds strong performance-based relationships, manages through roadblocks and barriers to success, and builds processes and protocols to ensure continued sustainability of initiatives and business processes. This position will have high visibility with USPI leadership.

He/She will work directly with Tenet and CBO leaders, along with market and hospital administrative leaders, to develop and execute market strategies and tactics that are in alignment with company goals.Manage multi-disciplinary process improvement by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence administrative teams and physicians to change processes to improve performance. May assist with the designing of and providing input needed for implementation and optimization of documentation systems (Cerner ACM, etc.) to standardize workflow and achieve key indicators.

Requirements:

• RN candidates must possess an active RN license and BSN is required.
• Social Work candidates must possess an active Social Worker license and master’s degree is required.
• A minimum of 5 years of Case Management leadership experience in an acute hospital or surgical hospital setting required.
• Must be able to travel regionally up to 75%. Selected candidate will be required to pass a Motor Vehicle Records check.
• Strong Presentation skills a must– development and presentation of content.
• Analytical ability is required to perform audits, to develop educational materials, and to develop strategic plans.
• Interpersonal skills required to interact with case managers, administration, and communicate standards to department Directors and medical staff.
• Self-Starter with the ability to ask questions and escalate to resolve barriers.

Preferred:

• Multi-site acute-care Case Management leadership experience preferred.
• Advanced degrees in Business, Nursing and/or Health Care Administration are preferred.
• Accredited Case Manager (ACM) preferred.
• Experience with Cerner ACM and InterQual preferred.
• Change and Project management experience; strong analytical skills including use of Excel and PowerPoint, and the ability to manipulate and analyze data preferred.

Compensation:

• Pay: $120,016 - $191,568 annually. Compensation depends on location, qualifications, and experience.
• Position may be eligible for an Annual Incentive Plan bonus of 10%-25% depending on role level.
• Management level positions may be eligible for sign-on and relocation bonuses.

Benefits:

The following benefits are available, subject to employment status:

• Medical, dental, vision, disability, life, AD&D and business travel insurance
• Manager Time Off – 20 days per year
• Discretionary 401k with up to 6% employer match
• 10 paid holidays per year
• 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.
• For Colorado employees, paid leave in accordance with Colorado’s Healthy Families and Workplaces Act.

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