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:
Conduct financial analysis, develop business plans and secure approval for programs
Develop strategies to manage and prevent disputes and improve Revenue Cycle processes with Revenue Cycle Directors
Build trusting relationships with hospital and Conifer leaders to successfully implement new programs
Build collaborative partnerships and lead cross functional teams to execute on plans and proposals
Identify process inefficiencies via root cause analysis and design work flow to address opportunities identified
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
Additionally, the Senior Director, Utilization Review is responsible for the following:
Leading centralized utilization review team structure and operations management to effectively support revenue cycle process and denial prevention.
Directing Tenet implementation of new technology to support utilization review processes.
Manage Tenet Case Management contract with Conifer for related services.
Serve as communications and Conifer Resource Center to align and optimize case management processes related to revenue cycle, denial prevention and appeals.
Lead successful denials prevention and performance improvement for Tenet hospitals.
Serve as Tenet case management lead with Managed Care Contracting to identify and address payer issues.
Provide indirect operations oversight to the market Authorization Team Managers
A minimum of seven years of hospital or health care leadership is required.
Experience successfully implementing centralized Utilization Review Teams for multi-hospital system strongly preferred.
Project management and Business Planning experience required.
Strong analytical skills, including use of Tableau and Excel, is required.
Executive communication and presentation skills, including ability to use PowerPoint is necessary.
A Bachelorï¿½s degree in Business, Nursing and/or Health Care Administration is required and an advanced degree strongly preferred.
Accredited Case Manager (ACM) or Certified Public Accountant (CP) preferred; Six Sigma Green Belt preferred.
Valid Registered Nurse (RN) preferred.
A competitive compensation program will be tailored to the selected candidate. Base salary will be supplemented by a performance bonus and comprehensive, well-rounded benefits program, which includes relocation assistance.
Approximately 50 percent.
Job: Executive Search
Primary Location: Dallas, Texas
Facility: Tenet Executive Search
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: 1905040116
About Tenet Executive Search
“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.