MetroWest Medical Center is the largest community health care system between Worcester and Boston. MetroWest Medical Center is committed to providing high quality, comprehensive care, at a location close to home. The 307-bed regional healthcare system includes Framingham Union Hospital, Leonard Morse Hospital in Natick and the MetroWest Wellness Center. MetroWest Medical Center has been named to the 2019 Americaï¿½s 100 Best Hospitals List by Healthgrades.
Under general supervision and according to established policies and procedures, provides leadership and direction to the Case Management Department. Reports to the Director of Case Management.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Oversees all utilization management and discharge planning functions of MetroWest Medical Center
Develops policies, and processes to ensurecompliance of all MWMC payors, Joint Commission standards, and Tenet utilization and discharge planning policies and regulations
Is responsible for all day to day operations of Case Management Department.
Develops and maintains processes for ensuring reimbursement for inpatient and observation level care. Is responsible for upfront denial prevention. Communicates all cases to be appealed for denied cases as appropriate.
Provides feedback to Director related to personnel and provides timely feedback, coaching, and teaching to staff as needed.
Collects and provides utilization data to the Medical Staff, Nursing and Administration
When necessitated by low staffing levels, performs case manager functions
Collaborates with nursing and other department directors to ensure patient safety on discharge and effective utilization
Maintains relationship with all payers, and outside agencies.
Current licensure as a Registered Nurse in the Commonwealth of Massachusetts
3-5 years of inpatient acute care Case Management experience. 3+ years of experience in a leadership role preferred.
Proficiency in MS Office (Word, Excel, Outlook, Power Point, Strong understanding of utilization
Job: Case Management/Home Health
Primary Location: Framingham, Massachusetts
Facility: MetroWest Framingham Union Hospital
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.
Internal Number: 1905036100
About MetroWest Framingham Union Hospital
“Tenet Healthcare Corporation is a diversified healthcare services company with 115,000 employees united around a common mission: to help people live happier, healthier lives. Through its subsidiaries, partnerships and joint ventures, including United Surgical Partners International, the Company operates general acute care and specialty hospitals, ambulatory surgery centers, urgent care centers and other outpatient facilities. Tenet's Conifer Health Solutions subsidiary provides technology-enabled performance improvement and health management solutions to hospitals, health systems, integrated delivery networks, physician groups, self-insured organizations and health plans.