Under the direction of the Vice President Performance Excellence and reporting directly to the Performance Excellence Policy & Education Director, the Performance Excellence (PE) Director Complex Case Management is responsible to oversee complex case management in collaboration with hospital case management, the Chief Nursing Officer and Chief Financial Officer. Serves as a member of the Performance Excellence team to improve patient throughput and implement standard work, aka Tenet Operating System (TOS) with specific focus on complex case management initiatives. 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.
Key focus on designing complex case management work to improve quality, patient experience and throughput while achieving cost efficiency and productivity targets in Tenet hospitals. Facilitates the assessment, planning and implementation of consistent standardized processes based on identified opportunities that drive improved patient care and capacity. 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 partner with the market and hospital Administrative leaders to ensure complex case management strategies are executed at the local level. He/She will work directly with Tenet and Conifer leaders to develop market strategies and tactics that are in alignment with company goals.
Uses lean tools in conjunction with the PE Management Engineers to lead the conception, issue identification, hypothesis formation, planning and conducting interviews. Develops and implements best practices to achieve organizational goals through effectively leading and managing change in a matrix environment. Develops and implements patient centered complex case management action plans. Monitors progress toward goals and addresses barriers and challenges while making adjustments as needed in a supportive, synergistic manner. Collaborates with legal, medical and nursing leadership, PE team members, resource management, case management/social work, discharge planning and utilization management to develop and implement methods to optimize use of hospital services.
Develops and implements Tenet complex case management program by utilizing excellent communication and servant leadership skills to challenge status quo and positively influence change processes to improve performance. Provides guidance to ensure patient throughput goals - including length of stay and care variation - are met by working with interdisciplinary teams and entities to coordinate patient flow into and through the hospital. Fosters an environment that promotes team member support, partnership, growth and development by assessing the needs of the team and implementing programs to meet those needs. Provides analysis and education regarding regulatory and clinical changes impacting complex case management process and hospital reimbursement. Provides education and tools for educating physicians and staff regarding complex case management process standards.
Works in alignment with assigned leadership teams and consistently demonstrates ability to:
Lead and collaborate with teams
Build trusting relationships with hospital and regional leaders
Build collaborative partnerships
Identify process inefficiencies via root cause analysis and design work flow to address
Conduct financial analysis and provide budget input as needed
Develop and implement action plans managing follow up to achieve outcomes
Implement targeted process changes including ongoing metric monitoring and management to achieve goals and drive improvement
Overall responsibility for the management of medically and/or socially complex patient populations for assigned hospitals 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.
Responsible for oversight to integrate 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
Up to 50% travel - as travel is required, we will run a MVR on the final candidate.
Current RN license, LCSW or LMSW and bachelor's degree required. A minimum of 7 years Case Management leadership experience in an acute setting required. Accredited Case Manager (ACM) preferred. Multi-site leadership experience preferred. Change and Project management experience; strong analytical skills including use of Excel and PowerPoint, and the ability to manipulate and analyze data preferred. Strong Presentation skills a mustï¿½ development and presentation of content. Advanced degree in Business, Nursing and/or Health Care Administration preferred.
Primary Location: Los Angeles, California
Facility: 984-Fort Lauderdale, FL
Job Type: Full-time
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.
Internal Number: 1805024614
“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.