Healthcare Utilization Leader - Drive Outcomes & Throughput

Tenet Healthcare Corporation; Detroit (MI); On-site; USD 120,000 - 160,000; Full time

Benefits offered by this job

Medical, dental, vision, and life保险

401(k) retirement plan with employer 1

Generous PTO

Career development and continuing教育

Health savings accounts

Employee Assistance program

Employee discount program

Pet insurance

Legal insurance

Accident and critical illness coverage

Long term care

Elder care

Auto and home insurance

Job summary

Detroit Medical Center is seeking a healthcare leader to drive excellence in Utilization Review and Case Management, ensuring medical necessity and appropriate levels of care while promoting timely throughput and safe discharge.

The role includes educating physicians and staff, coordinating with payers, and reporting to hospital leadership on utilization metrics and denials data, within Tenet's standards.

Qualifications

• Leader with experience in healthcare operations.
• Experience coordinating Utilization Review and Case Management.
• Strong knowledge of regulatory requirements and accreditation standards.

Responsibilities

• Facilitate and support an effective Utilization Review program within Case Management.
• Ensure care is provided at the appropriate level based on medical necessity.
• Negotiate with payers on a case-by-case basis for timely payments.
• Provide education to physicians and Case Management staff as needed.
• Generate reports and monitor utilization metrics for leadership.

Skills

Leadership

Healthcare management

Utilization review

Case management

Regulatory compliance

Job description

Detroit Medical Center is seeking a healthcare leader to drive excellence in Utilization Review and Case Management, ensuring medical necessity and appropriate levels of care while promoting timely throughput and safe discharge.

The role includes educating physicians and staff, coordinating with payers, and reporting to hospital leadership on utilization metrics and denials data, within Tenet's standards.