Brookwood Baptist Medical Center:Located in Birmingham, this 588 bed facility provides the following services: Brain & Neuro, Cancer Care, Children's Services, Diagnostics, Digestive Disorders, Ear, Nose & Throat, Emergency, Gynecological Surgery, Heart Care, infertility issues, Interventional Radiology, Maternity, Orthopedics, Pain Management, Psychiatry (one of the largest providers in the State), Pulmonary and Respiratory, Rehabilitation Services, Robotic Surgery, Sleep Center, Surgical Services, Urology, Weight Loss Surgery, Women's Health, Workforce Wellness, and Wound Care.
The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patientâ��s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including:
Utilization Management services supporting medical necessity and denial prevention
Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
Accurate medical necessity screening and submission for Physician Advisor review
Securing and documenting authorization for services from payers
Managing concurrent disputes
Collaborating with payers, physicians, office staff and ancillary departments
Timely, complete and concise documentation in the Tenet Case Management documentation system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting over and underutilization
Required: Graduate of an accredited school of nursing.
Preferred: Academic degree in nursing (bachelor's or master's)
Required: 2 years pf acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting.
Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered. Preferred: Accredited Case Manager (ACM).
Lift/position up to 25 lbs. Push/pull up to 25 lbs. of force.
Frequent sitting. Moderate standing, walking, reaching, stooping, and bending
Manual dexterity, mobility, touch, auditory to perform all the related duties of the position
Primary Location: Birmingham, Alabama
Facility: Birmingham Market Office
Job Type: PT2Y
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.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.