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 & dependent flexible spending accounts
- Employee assistance program, employee discount program
- Voluntary benefits including 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 includes supporting the advancement of centralized Utilization Review as a leader, mentor, and consultant; executing strategic initiatives; and providing subject‑matter expertise for Case Management – Utilization Review regulations and standards, including ensuring compliance with all state and federal regulations.
Position Specific Responsibilities
- Develop and maintain procedure manuals for activities such as the UM annual work plan/evaluation and quarterly and semi‑annual UM reports.
- Oversee daily operations of the UM team and optimize denial mitigation processes.
- Partner with the Group DCM and Hospital Case Mgt. Leaders regarding Case Management scope of services, including utilization management, transition management, promotion of appropriate length of stay, readmission prevention, and patient satisfaction.
- Ensure effective utilization of resources, timely and accurate revenue cycle processes, denial prevention, and safe and timely patient throughput.
- Integrate national standards for utilization management supporting medical necessity and denial prevention.
Qualifications
- Bachelor’s degree in business, nursing, or health care administration required; advanced degree in business, nursing, healthcare administration, health science or related discipline preferred.
- Minimum of 5 years’ experience in hospital revenue cycle function. Five (5) 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 related duties of the position.
Facility Description
The Detroit Medical Center (DMC) is a nationally recognized health care system serving 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 DMC include 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. 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, attracting national and international attention, and stands as one of the largest and most diverse employers in Southeast Michigan.
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. The employment practices of Tenet Healthcare and its companies comply with all applicable laws and regulations.
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