Jobs in the United States

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Added 5 mins ago
Occupational Therapist - Education and Development Intervention Services (EDIS)
ERP International
Maxwell AFB, AL
ERP International is seeking an Occupational Therapist for a Part-Time position in support of the Education and Development Intervention Services (EDIS) program of the 42 Medical Group at…
Added 5 mins ago
Supervisory Healthcare Engineer (Detail/Temporary Promotion NTE 120 Days)
Veterans Affairs, Veterans Health Administration
Tuskegee, AL
Added 6 mins ago
HR Generalist - DC (Bessemer) - 2nd Shift
Dollar General
Bessemer, AL
o Compliance- Monitors and recommends actions to comply with state and Federal employment law and Company policy. Provides orientation to new employees regarding required compliance.…
Added 6 mins ago
RRT (RCP II) 12 Hr - RRAL
Prime Healthcare
Gadsden, AL
…acute-care hospital serving more than 350,000 residents in Etowah and the contiguous counties. A full range of services and programs are offered, including the only accredited Cath Lab in…
Added 6 mins ago
Hospital and Patient Services Manager (Business Development)
Fresenius Medical Care
Birmingham, AL
Review and comply with the Code of Business Conduct and all applicable company policies and procedures, local, state and federal laws and regulations.
Added 6 mins ago
Retail Manager - Birmingham, AL
Compass Group, North America
BIRMINGHAM, AL
…driving history), in a manner consistent with all applicable federal, state, and local laws, including the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San…
Added 6 mins ago
Sustainment Financial Analyst (P2) *HYBRID*
RTX Corporation
huntsville, AL
…Strategic Business Unit of Raytheon is seeking a highly motivated and self-driven early in career finance professional (P2) to assume the role of Sustainment Financial Analyst, reporting…
Added 6 mins ago
Supervisor Assistant Nurse Manager
Veterans Affairs, Veterans Health Administration
Huntsville, AL
Added 6 mins ago
OneStream Lead Analytics and Insights Engineer II Manager
Deloitte
Huntsville, AL
Deloitte's Government & Public Services (GPS) practice - our people, ideas, technology and outcomes - is designed for impact. Serving federal, state, & local government clients as well as…
Added 6 mins ago
Technical Program Manager, Knowledge Systems
Coinbase
Montgomery, AL
…accurate knowledge across customer self-service, internal tools, and AI-assisted support. As Technical Program Manager, you will translate knowledge strategy into technical execution. This…
Added 6 mins ago
Manager, Field Sales
Wolters Kluwer
Montgomery, AL
Research and Learning, US (CCHGroup.com) is part of Wolters Kluwer Tax & Accounting, one of the world's leading providers of tax, accounting and audit information, solutions and services to…
Added 6 mins ago
Data Center Facility Operations Area Director
Meta
Montgomery, AL
…Operations across a multi-area region, including operating campuses and future sites that are yet to be announced or built. This role owns the multi-year operating strategy for its region,…
Added 6 mins ago
Manager, Enterprise Communications & Channels
Amentum
Montgomery, AL
The Manager, Enterprise Communications & Channels is responsible for developing and delivering employee communication programs that inform, engage, and connect employees to Amentum's…
Added 17 mins ago
V
Global Compliance & Privacy Officer
Vontier
Jefferson City, MO
- $147,290 to $200,000 USD / year
+ Develop and maintain the company's global ethics and compliance program.
Added 20 mins ago
Registered Nurse - RN
Fresenius Medical Care
Dundee, MI
Empower, engage, and train dialysis patients on peritoneal and home hemodialysis using state of the art training programs and equipment.
Added 20 mins ago
TH
LPN/RN Full Time Afternoon
Trinity Health
Fraser, MI
- Full-time
The Nurse Manager provides direct nursing care to the residents and supervises the day-to-day nursing activities performed by nursing shift staff. Such supervision must be in accordance…
Added 20 mins ago
Fleet Maintenance Manager
Republic Services
Pontiac, MI
POSITION SUMMARY: The Fleet Maintenance Manager is responsible for the management of fleet equipment at one or more locations and managing a team(s) of technicians who are responsible for…
Added 20 mins ago
Respiratory Therapist Clinical Specialist - 36 Hours Midnight Shift
Henry Ford Health System
Jackson, MI
Under general direction, the Respiratory Therapist-Clinical Specialist (RT-CS) provides direction and supervision in the role of on-site Respiratory Therapy leader. In line with the AARC…
Added 20 mins ago
Engineering Group Manager - Seat Complete
General Motors
Warren, MI
The Seat Complete Engineering Group Manager (EGM) is the technical and people leader responsible for the successful development, integration, and delivery of complete seat systems across…
Added 20 mins ago
Utilization Manager
Tenet Healthcare
Detroit, MI
· Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with Tenet policy as well as any state or federal program requirements.
Added 21 mins ago
Dialysis Clinical Manager Registered Nurse - RN
Fresenius Medical Care
Lansing, MI
Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning for our managers. The curriculum will cover onboarding,…
Added 21 mins ago
Manager Strategic Risk Adjustment Programs
Highmark Health
Jefferson City, MO
This job provides end-to-end management, delivery and support to new and existing Risk Adjustment Programs. The incumbent will deliver value to the Health Plan, and its beneficiaries…
Added 39 mins ago
Hotel Admin - Kindred
Vail Resorts
Keystone, CO
We follow all federal, state, and local laws including restrictions on child/minor labor. Minors hired into this position will not be asked or permitted to engage in any activities…
Added 39 mins ago
Assistant General Manager- Front of House - Mountain House - Winter Seasonal
Vail Resorts
Keystone, CO
The Food and Beverage (F&B) Organization is comprised of over 300 different restaurants that share a commitment to bringing excellence to mountain dining as part of the overall ski…
Added 40 mins ago
Assistant Manager :Ski & Ride School - Salary
Vail Resorts
Vail, CO
The Ski & Snowboard School Assistant Manager is responsible for delivering high-quality guest and employee experiences while supporting the overall success of ski and snowboard school…

Detroit Medical Center Shared Services

Utilization Manager

Detroit, MI, United States

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Job details

Posting language: English

Original job description

Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At The Detroit Medical Center (DMC) , we’re seeking an innovative and experienced healthcare leader to drive excellence and inspire our team towards exceptional patient outcomes and operational success. Benefit Statement At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

Medical, dental, vision, and life insurance
401(k) retirement savings plan with employer match
Generous paid time off (PTO)
Career development and continuing education opportunities
Health savings accounts, healthcare C dependent flexible spending accounts
Employee Assistance program, Employee discount program
Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder C childcare, auto C home insurance. Note: Eligibility for benefits may vary by location and is determined by employment status The individual in this position is responsible to facilitate and support an effective Utilization Review program within the Case Management department, which may be centralized within a specific market or group. The individual in this position has overall responsibility to ensure that care is provided at the appropriate level of care based on medical necessity and assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case by case basis. This position integrates national standards for case management scope of services to include: · Provides assistance to the Director of Case Management in the management of the Utilization Review/ Central Utilization Review department, but not limited to, hiring/training/managing staff, schedule coordination, analysis and reporting, interfacing, collaborating and working closely with the other departments. · Accountable for compliance with state and federal regulatory requirements, TIC accreditation standards and Tenet policy. · Provides education to physicians, physician advisors, Case Management staff, and other hospital leaders as needed. Identify and provide physician education and feedback on hospital utilization and disputes/denials data. · Review weekly Case Management Utilization Review (UR) and Continuing Care (CC) scorecards/metrics, Observed/Expected Length of Stay, Authorizations and Downgrades. Provides reports to DCM and hospital leadership as requested. · Maintains knowledge of current contractual arrangements with Health Plans and Vendors. Partners with Managed Care representatives in JOC and other payer meetings to collaborate and communicate better outcomes. · Organize the concurrent authorization process to meet utilization management needs and monitor turn-around times to meet health plan requirements. Implement and monitor processes to prevent payer disputes. · Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with Tenet policy as well as any state or federal program requirements. The individual's responsibilities include the following activities: a) accurate medical necessity screening and submission for Physician Advisor review, b) securing and documenting authorization for services from payers, c) managing concurrent disputes, d) collaborating with payers, physicians, office staff and ancillary departments, e) timely, complete and concise documentation in the Tenet Case Management documentation system, f) maintenance of accurate patient demographic and insurance information, g) identification and documentation of potentially avoidable days, h) identification and reporting over and underutilization, i) and other duties as assigned.

QUALIFICATIONS:

Required qualifications include an active Registered Nurse license with at least two years acute hospital patient care, hospital case management, utilization review, healthcare, or leadership experience. B.S.N. preferred, ***unless higher degree required for Magnet Hospital Status. Accredited Case Manager (ACM) preferred. Acute hospital case management or supervisory 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.

Facility Description The Detroit Medical Center (DMC) is a nationally recognized health care system that serves patients and families throughout Michigan and beyond. A premier healthcare resource, our mission is to help people live happier, healthier lives. The hospitals of the Detroit Medical Center are the Children's Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women's Hospital, the DMC Heart Hospital, Huron Valley-Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai-Grace Hospital. EEO Statement Employment practices will not be influenced or affected by an applicant’s or employee’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 participates in the E-Verify program. Follow the link below for additional information. E-Verify: http://www.uscis.gov/e-verify The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations

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Skills

RN
Patient care
Case management
Leadership
Organizational skills
Communication skills
Critical thinking
Problem solving
Computer skills
Health care system

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