Group Director - Utilization Review

Overview
Are you a results-driven leader ready to make a meaningful impact to patients, caregivers, and your community? At

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.

Benefits

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 & 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 & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

Summary
The Group Director, Utilization Review will perform the functions necessary to support and advance Tenet’s Case Management strategy with a specific focus on Utilization Review for the designated Market. The role will support the advancement of Centralized Utilization Review as a leader, mentor, and consultant, executing on strategic initiatives and providing subject matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations.

Responsibilities
The Group Director will be responsible for developing and maintaining procedure manuals for such activities as: UM annual work plan/evaluation and quarterly and semi-annual UM reports; oversight of daily operations of the UM team and optimizing denial mitigation processes.

Will partner with the Group DCM and Hospital Case Mgt. Leaders relating to Case Management scope of services, including utilization management, transition management promoting appropriate length of stay, readmission prevention and patient satisfaction.

Will ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput. Will integrate national standards for utilization management supporting medical necessity and denials prevention.

Qualifications

Bachelor’s degree in business, nursing or health care administration required. Advanced degree in business, nursing and/or healthcare administration, health science or related discipline preferred.

A minimum of 5 years’ experience in hospital revenue cycle function. Five years in hospital Utilization Review Leadership preferred. Multi‑site leadership experience preferred. Experience successfully implementing centralized Utilization Review teams for a multi‑hospital system strongly preferred. Working knowledge of CarePort and MIDAS documentation and reporting required. Project Management and Business Planning experience; strong analytical skills including use of Tableau and Excel; executive communication and presentation skills including ability to use PowerPoint.

Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six Sigma Green Belt preferred.

Valid Registered Nurse (RN) preferred.

Physical Demands

Lift/position up to 25 lbs. Push/pull up to 25 lbs of force.

Frequent sitting. Moderate standing, walking, reaching, stooping, and bending.

Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.

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 include Children’s Hospital of Michigan, Detroit Receiving Hospital, Harper University Hospital, Hutzel Women’s Hospital, DMC Heart Hospital, Huron Valley‑Sinai Hospital, the Rehabilitation Institute of Michigan and Sinai‑Grace Hospital.

DMC’s 150‑year legacy of medical excellence and service provides patients and families world‑class care in cardiovascular health, women's services, neurosciences, stroke treatment, orthopedics, pediatrics, rehabilitation, organ transplant and other general and specialty services.

DMC is a key partner in Detroit’s resurgence, which continues to draw national and international attention. A dedicated corporate citizen with strong community ties, DMC is one of the largest and most diverse employers in Southeast Michigan.

Equal Employment Opportunity 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 13 legally protected status. Tenet will make reasonable accommodation for qualified individuals with disabilities unless doing so would result in an undue hardship. Tenet participates in the E‑Verify program.

Job Type: Full‑time

Shift Type: Days

Primary Location: Detroit Medical Center Shared Services

Job Number: 2606001720

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