Since 1972, Placentia-Linda Hospital has expanded right along with north Orange County. As our communities grow, we continue to offer a full range of medical services to meet your family’s needs. One thing remains the same — our caring and compassionate staff, which is committed to providing excellent quality and customer satisfaction. The numerous awards and distinctions we’ve earned demonstrate that. The Joint Commission, the leading accreditor of healthcare organizations in America, once again named Placentia-Linda Top Performer on Key Quality Measures in 2014. The hospital was recognized for exemplary performance in using evidence-based clinical processes that are shown to improve care for certain conditions.
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 support the Director of Case Management (DCM) in the 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) support the management of department operations to assure effective throughput and reimbursement for services provided, b) supports DCM in 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) collaborates with physicians, office staff, and ancillary department, g) ensure compliance with state and federal regulations and TJC accreditation standards, h) lead complex case review in DCM’s abscenses, i) assist DCM with onboarding of new employees and education of staff, j) support coaching and performance management of staff with DCM, and k) other duties as assigned.
Required qualifications include an active Registered Nurse license with at least two years acute care Case Management Experience.
Leadership role preferred.
Accredited Case Manager (ACM) preferred.
McKesson InterQual® 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.
Internal Number: 2005019997
About Placentia-Linda 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.