Role Description 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 patient’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
• May oversee work delegated to Central Utilization Review LVN/LPN Case Manager and/or Central Utilization Authorization Coordinator

Qualifications

• Registered Nurse license
• Experience in case management
• Strong communication skills
• Ability to work collaboratively with healthcare teams

Requirements

• Knowledge of medical necessity criteria
• Ability to negotiate with payers
• Understanding of state and federal regulations

Benefits

• 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

Company Description

Tenet’s hospital operations segment includes 52 acute care and specialty hospitals in nine states, as well as other facilities such as primary and specialty care clinics, diagnostic imaging centers, micro-hospitals and off-campus emergency departments. Our hospitals are well known for delivering excellent medical care and offering a complete range of services tailored to the needs of each community we serve. From preventative and diagnostic services to expertise in some of the world’s leading technologies, we work with multidisciplinary teams of physicians and healthcare professionals dedicated to the good health and well-being of our neighbors. Tenet also offers opportunities to work at the corporate level in Dallas, TX and in the markets we serve. Corporate and executive positions support the mission of the enterprise.