Clinical Supervisor - PAC - UM

The Post-Acute Care Program assists with reducing hospital readmissions of clinically complex patients. The program couples patient education/coaching with Home Health interventions to assist a patient’s transition home after a hospital stay. Staff works directly with patients in transitioning from hospital to home with a focus on short term self-recovery in the home and long term ongoing care management of their healthcare. Assess patients care needs through assessments that are completed in home and/or telephonically, treatment plan creation to mitigate care gaps, facilitate in home health care services to accomplish the treatment plan patient goals, patient education/coaching along with adherence/compliance monitoring.

This position functions as the Supervisor of the Post-Acute Care team and primary point of contact for day to day clinical questions, concerns from internal and external clients and provides team leadership and guidance regarding patient centered interventions. Assists in development of Post-Acute Care training, job aids and tools and desk level procedures. Provides clinical oversight for nurses

In this Job you will:

• Supervise the Post-Acute Care team members (clinical), provides team leadership and guidance regarding patient centered interventions and oversees daily workload and makes assignments to ensure timely completion as needed.
• Function as lead clinical resource to all associates. Supports the management team with training, tools and clinical oversight for both clinical team members.
• Supervise all daily team activities, assigns tasks and responsibilities to appropriate team members. Monitors performance and productivity of team and individual members and takes appropriate action to ensure guidelines and goals of the department are met.
• Complete performance reviews and mentors the Post-Acute Care team members.
• Function as the lead clinical resource to Post-Acute Care team. Supports auditing Post-Acute Care cases and interventions to monitor outcomes, track/trend results and identify opportunities for process improvement.
• Work collaboratively with Provider Relations and provider network department to achieve desired goals.
• Work with the Clinical Management to implement best practices for care transitions, utilization and authorization management of selected home care services.
• Work with Clinical Management to support clinical and utilization management goals and objectives.
• Participate in special projects and performs other duties as assigned.
• Perform other duties as required or assigned.

This is the job for you if:

• You have previous management / leadership experience strongly desired but not required. Licensed professionals are required to possess a current license to practice without restrictions.
• You possess knowledge of State and Federal regulations in regard to Utilization Management and accreditation standards i.e. URAC, NCQA required.
• You possess excellent writing, organization, communication, and interpersonal skills.
• You are able to manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• You have excellent clinical knowledge and ability to lead and guide others to be successful.

You should get in touch if:

• You have an Associate's Degree or Diploma in Nursing/Practical Nursing or the equivalent and a clear and active
• You are a Registered Nurse/LPN/LVN (based on allowable state practice act) license in any state(s) or jurisdiction in the United States is required.
• You are Licensed in the state where providing PAC services.
• You have a minimum of 4-6 years' experience with thorough knowledge of healthcare, case management, re-engineering processes, managed care regulations, utilization management, contract terms/stipulations, capitation requirements and governmental home health agency regulations also required.
• You have a minimum of 1-2 years prior authorization experience for Medicare or Medicare Advantage Home Health required.
• You have a minimum of 2 years in a clinical setting (required).
• You have 1-2 year’ experience in Interqual (desired).
• You hold strong knowledge of Medicare PDGM and 1-2 years process experience strongly desired.
• You hold a broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/review experience, and governmental home health agency regulations preferred.

What we offer:

• Salary Range: $72000 - $95000 / year plus Corporate Bonus Incentive.
• Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match
• Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more
• Advancement Opportunities, professional skills training, and tuition /exam reimbursement
• PayActiv - access earned income in between pay checks
• Walgreens Discount - receive up to 25% off eligible items
• Great culture with a sense of community

CareCentrix maintains a drug-free workplace

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We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

CareCentrix accepts applications on an ongoing basis until a candidate is identified.