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DMC Detroit Receiving Hospital, Michigan�s first Level I Trauma Center, helped pioneer the evolution of emergency medicine and currently has one of the busiest and most well-equipped emergency departments anywhere. The first and largest verified burn center in the state is at Receiving, and it is one of only 43 in the nation. Receiving also offers the state�s leading 24/7 hyperbaric oxygen program, Metro Detroit�s first certified primary stroke center, and the nationally recognized and accredited DMC Rosa Parks Geriatric Center of Excellence.

Job Description:
Under general direction and according to established policies and procedures, monitors patient care for quality assurance, utilization review and risk management activities.

� Determines appropriateness and medical necessity of admission, continued hospital stay and use of ancillary services.

� May perform pre-authorizations, concurrent review and retrospective review audits. May troubleshoot patient issues with Patient Management, as needed.

� Reviews and monitors patient medical records for complete, timely and accurate entries.

� Communicates with third party payors and develops appeals to overturn adverse payment decisions; provides technical assistance to clinical and administrative staff regarding the development of quality improvement indicators/monitors, measurement methodology and charting techniques; conducts special studies and prepares report findings.

� May participate in the development, education and maintenance of the DMC Continuous Improvement Program.

� Facilitates the preparation of JCAHO and other licensing body requirements of accreditation.

� Develops and presents in-services to clinical and administrative staff regarding documentation and findings from reviews, as necessary.

1. Bachelor's degree in Nursing, Medical Records or health care field, or equivalent combination of education and/or related experience. Registered Nurse preferred.

2. Two to three years progressively more responsible clinical and/or Quality Assurance/utilization Review experience.

3. Coursework and experience in research statistics and quality improvement methodology, including chart control techniques, preferred.

Employment practices will not be influenced or affected by an applicant�s or employee�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.