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Senior Director, Utilization Review
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- Leads Tenet Hospital case management operations to develop and implement centralized utilization review and authorization management services by market or region to promote an appropriate level of care and prevent payer denials.
- Serves as the Tenet leads with Tenet National Director Clinical Denials, Sr. Director Revenue Cycle, hospital CFOs, Directors Revenue Analysis (DRAs), and Managed Care Contracting to design concurrent processes to secure authorizations and prevent clinical denials.
- Lead Tenet Utilization Review Teams market structure and operations management to effectively support utilization review and authorization confirmation functions to promote an appropriate level of care and prevent payer denials.
- Works with National Director Clinical Denials and Managed Care Contracting to identify and manage Payer Portal and address payer issues.
- May assist with the designing of and providing input needed for implementation and optimization of documentation systems (Cerner, PBAR, CarePort, MIDAS, etc.)
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