The dedicated staff, highly-skilled physicians and surgeons, and advanced technology combine to make working at Los Alamitos Medical Center a personally-rewarding work environment. Nursing staff often hold advanced degrees, are dedicated to caring for others in both their personal and professional lives, and work side-by-side with talented colleagues and medical staff. The hospital has an advanced bi-plane catheterization lab, robot-assisted surgery capabilities, an Orthopedic Destination Center, and the radiation oncology physician services are provided by UCLA Health. Outpatient services are provided in a colorful patient setting in our Total Care Pavilion and there will soon be nurse navigators to assist orthopedic and cancer patients. The hospitalâ��s quality indicators reflect the hard work of physicians and staff. LAMC awards and distinctions include an A on the Leapfrog Hospital Safety Score, American Heart Association Get with the Guidelines Gold+ Performance Achievement Award for Heart Failure, American Stroke Association Get with the Guidelines Gold+ Performance Achievement Award for Stroke, American Stroke Association Target Stroke Honor Roll, and is a Joint Commission Advanced Primary Stroke Center. Los Alamitos Medical Center is a great place to work. There are more than 150 staff members who have been here over 20 years and the hospital has been in the community for nearly 50 years treating generations of families.
We offer competitive salaries and benefits including a matching 401(k), several health & dental plans to choose from, generous tuition assistance plans, and relocation assistance for select positions.
The individual in this position has overall responsibility for hospital utilization management, transition management and operational management of the Case Management Department in order to promote effective utilization of hospital resources, timely and accurate revenue cycle processes, denial prevention, safe and timely patient throughput, and compliance with all state and federal regulations related to case management services.
This position integrates national standards for case management scope of services including:
Utilization Management supporting medical necessity and denial prevention
Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
Education provided to physicians, patients, families and caregivers
The individualâ��s responsibilities include the following activities:
Manage department operations to assure effective throughput and reimbursement for services provided
Lead the implementation and oversight of the hospital Utilization Management Plan using data to drive hospital utilization performance improvement
Ensure medical necessity and revenue cycle processes are completed accurately and in compliance with CMS regulations and Tenet policy
Ensure timely and effective patient transition and planning to support efficient patient throughput
Implement and monitor processes to prevent payer disputes
Develop and provide physician education and feedback on hospital utilization
Participate in management of post-acute provider network
Ensure compliance with state and federal regulations and TJC accreditation standards, andi) other duties as assigned.
Required: Bachelor degree in Business, Nursing or Health Care Administration for RN or Master's in Social Work for MSW.
Preferred: MSN, MBA, MSW or MHA.
Required: 3 years of acute hospital case management or healthcare leadership experience.
Preferred: 5 years of acute hospital case management leadership multi-site experience.
Required: Registered Nurse or LCSW/LMSW license. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN or LCSW/LMSW license for state(s) covered.
Preferred: Accredited Case Manager (ACM)
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
Tenet complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
Job: Managers and Directors
Primary Location: Los Alamitos, California
Facility: Los Alamitos Medical Center
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.