Group Director, Utilization Review - Baptist Health System
Baptist Health System
Location: San Antonio, Texas
Internal Number: 2105015304
The Case Management Manager has overall responsibility for coordinating the daily activities of the case management team, while overseeing the clinical plan of care to conform with evidence-based practice and/or regulatory/payor requirements.
The Case Management Manager integrates functions typically considered to be case management, care coordination and/or utilization management, and discharge planning assessment and coordination.
As such, the Case Management Manager 's responsibilities will include, but not be limited to the following activities:
Coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post-acute care) compared to evidenced-based practice, internal and external requirements.
Identify and report variances in appropriateness of medical care provided, over/under utilization of resources compared to evidenced-based practice and external requirements.
This priority includes work with relevant software and communicating information through clear, complete and concise documentation in CM software.
Effective collaboration with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes.
Remain current with relevant clinical / case management practices.
Assist Director with daily operational oversight and supervision of Departmental staff.
Required: Preferred: Bachelor of Science in Nursing (BSN) preferred.
Required: Active Registered Nurse license. Preferred: Accredited Case Manager (ACM)
Job: Managers and Directors
Primary Location: San Antonio, Texas
Facility: Baptist Health System
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.
Tenet Healthcare Corporation (NYSE: THC) is a diversified healthcare services company headquartered in Dallas with 112,000 employees. Through an expansive care network that includes United Surgical Partners International, we operate 65 hospitals and approximately 510 other healthcare facilities, including surgical hospitals, ambulatory surgery centers, urgent care and imaging centers and other care sites and clinics. We also operate Conifer Health Solutions, which provides revenue cycle management and value-based care services to hospitals, health systems, physician practices, employers and other clients. Across the Tenet enterprise, we are united by our mission to deliver quality, compassionate care in the communities we serve.