Senior Director, Utilization Review

Under the direction of the Vice President Case Management & Continuing Care, the Senior Director, Utilization Review (UR) has responsibility for oversight of the development, implementation and performance management of the Tenet Utilization Review and Denials Prevention program across all Tenet acute hospitals. The Senior Director is responsible for leading Tenet hospital case management redesign to develop and implement centralized utilization review and authorization management services, by market or region, to promote appropriate level of care, length of stay, and prevent payer denials. The Senor Director also serves as the Tenet lead with Tenet Senior Director Revenue Cycle, hospital CFOs, Directors Revenue Analysis (DRAs) and Managed Care Contracting to address root cause for denial prevention and appeals. He/she serves as Tenet lead with Conifer Senior Director Client Delivery for Tenet case management participation with denial management and prevention initiatives. The Senior Director serves as a member of the Case Management and Continuing Care leadership team to improve Tenet hospital patient care performance as measured by key indicators including level of care, length of stay, patient throughput and compliance metrics. Indirectly reporting to this position are the market or regional centralized UR Team Manager and/or Director positions.

The Senior Director, Utilization Review has responsibility for leading continuous improvement initiatives and best practice strategies across all Tenet hospitals to achieve organizational goals through standardized systems and processes. This position will partner with the market and hospital Administrative leaders to ensure the strategies are executed at the local level. He/she works directly with Tenet, Conifer and USPI leaders to develop market strategies and tactics that are in alignment with company goals. 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.

The Senior Director, Utilization Review utilizes lean tools in conjunction with the Performance Optimization team to address performance barriers. He/she is responsible for developing and implementing best practices to achieve organizational goals through effectively leading and managing change in a matrix environment. The Senior Director oversees the implementation of action plans and monitors progress toward goals, assisting with addressing barriers and challenges and making adjustments as needed in a supportive, synergistic manner. The Senior Director is responsible for collaborating with Medical and Nursing leadership, as well as case management and continuing care team members, to develop and implement methods to optimize use of hospital and post-acute services.

The Senior Director, Utilization Review has responsibility for managing 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. He/she may assist with the designing of and providing input needed for implementation and optimization of documentation systems (Cerner, First Net, MedHost, etc.) to promote data integration, improve work flow and achieve key performance indicators. Also, the Senior Director has responsibility for fostering 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. This executive provides analysis and education regarding regulatory and clinical changes impacting pre-hospital, inpatient and post-acute care processes and reimbursement. Additionally, the Senior Director provides education and tools for educating physicians and staff regarding programs and processes.

The Senior Director, Utilization Review works in alignment with hospital and Conifer leadership teams and consistently demonstrates ability to:

Additionally, the Senior Director, Utilization Review is responsible for the following: