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Form of workCommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.
If you are committed to social justice, health equity, and prepared to deliver care in new, innovative ways, you belong with us.
We offer the following benefits to support you and your family:
- Annual Incentive (Bonus) Program.
- Matching Retirement Program.
- Pension fully funded by the organization.
- Tuition Assistance for career growth and development.
- Health/Dental/Vision Insurance.
- Free Membership to our Care@Work program supporting child care, pet care, and adult dependent needs.
- Employee Assistance Program (EAP) for you and your family.
- Flexible spending accounts.
- Voluntary Protection: Group Accident, Critical Illness, and Identity Theft.
- Wellness Program.
- Paid Time Off (PTO).
- Manages programs that emphasize appropriate admissions, concurrent and retrospective review of care, and concurrent
denials. - Acts as a resource to the medical staff, administrative staff, divisional staff, as well as external regulatory agencies in all
issues relating to Utilization Management within the Markets. - Analyzes and reports significant utilization trends, patterns, and impact to appropriate departments and committees.
- Collaborates with Physician Advisory Services to identify denial root causes related to physician performance and facilitates
educational training for medical staff on issues related to Utilization Management. - Directs recruitment, performance management, coaching, mentoring, training and development. Educates and trains staff
on utilization review processes and guidelines. - Promotes collaborative practice with revenue cycle stakeholders and facilitates data sharing that provides insight into where
best to focus concentrated denial prevention and management efforts designed to reduce costly delays in payment and
maximize claims reimbursement revenue. - Shall be able to effectively monitor, evaluate and administer the resources of each assigned area, and make substantiated
recommendations regarding resource allocation needs for future planning purposes. - Collaborates with division and system leadership, revenue cycle, and other stakeholders to ensure achievement of denial
reduction and value capture goals.
Education and Experience:
- Bachelor's degree in Nursing, Health Care Administration or advanced clinical degree.
- Minimum 3 years of clinical case management (Utilization Management, Denial Management, Care Coordination).
- 5 years of progressively responsible management experience.
- Extensive operational experience in managed care; extensive experience in program planning, implementation, staff
development, and needs assessment. - Comprehensive knowledge of Utilization Management, financial management that includes revenue cycle, Medicare, Medicaid,
and commercial admission and review requirements. - Knowledge of CMS standards and requirements.
Licensure:
- Current Registered Nursing (RN) license in the State of California.
- National certification of any of the following: CCM (Certified Case Manager), ACM (Accredited Case Manager) required or
within 2 years upon hire.
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