Clinical Supervisor - UM - Commercial

The Utilization Management (UM) Clinical Supervisor of the Home Health team oversees the department’s activities including serving as a resource for the utilization management program and clinical guideline application assisting with clinical data collection, analysis, and reporting, supporting operations and management team with clinical feedback and utilization training, tracking and monitoring turnaround times to assure service requirements are met, coordinating with operations and clinical team members to intervene when service levels are at risk, providing appropriate issue resolution and/or escalation when necessary, assuring timely letter generation and mailing, and coordinating the with Quality Department in preparation for internal and customer audits. The UM Clinical Supervisor for the Home Health team ensures that the team’s denials, physician review processes, and turnaround times comply with customer, regulatory, and accrediting agency standards, and all CareCentrix standards and policies. Trains new team members and performs ongoing training of the existing team. Monitors performance of team and individual members to take appropriate action to ensure department goals are met. Works under general supervision.

In this Job you will:

• Possess excellent communication (verbal/written), organizational and interpersonal skills.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.

• Effectively supervise Home Health activities including but not limited to clinical consultation, the elevation of cases for physician review, data collection, analysis, reporting, tracking, issue resolution, turnaround time compliance, personnel management, and cross-departmental collaboration.

• Collaborate with multiple departments and teams to develop and implement best practice strategies and operational processes that drive process and performance improvements and ensure compliance with CareCentrix policies, customer requirements, legal requirements, and regulatory mandates.

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  Implement and maintain standardized operations processes to ensure compliance with CareCentrix policies, customer requirements, legal requirements and regulatory mandates.

• Work with our Workforce Management partners and the Quality Auditing department to define and implement quantitative performance measures to establish performance objectives and continuously raise performance standards.

• Oversee team impacts related to implementing a new client or process, conduct training needs analysis, ensure document preparation, and educate the team members on all updates.

• Participate in company initiatives extending to their team to assist with BRDs, Project Charters, process development, training activities, or others as assigned.

• Perform coaching on a monthly and follow-up basis for all team members for professional development. Allow growth opportunities as able, and address errors or audit findings. Utilizes screen capture audits. Develop team leads and supervise the team lead’s activity. All coaching must be memorialized in Quantum.

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  Work with our Human Resources (HR) and Talent Acquisition partners to screen and select candidates to interview as needed to ensure that a high-performing team is recruited and developed to achieve priorities.

   

• Attend/participate in staff development programs and obtain continuing education as company policy and licensing bodies require.

   

• Interact with referral sources to facilitate communications, answer questions, and resolve escalations.

   

• Participate in implementing/maintaining operational processes to promote compliance with Company policies, legal requirements, and regulatory mandates.

   

• Perform other duties as assigned.

This is the job for you if:

• You can attend/participate in staff development programs and obtains continuing education as required by company policy and licensing bodies. Interacts with referral sources to facilitate communications, answer questions and resolve problems.
• You have experence in participating in implementing / maintaining operational processes to promote compliance with Company policies, legal requirements and regulatory mandates.
• You will participate in special projects and performs other duties as assigned.

You should get in touch if:

• You hold a clear and active Registered Nurse/LPN/LVN (based on allowable state practice act) license in any state(s) or jurisdiction in the United States is required.
• You possess a minimum of five years' experience with thorough knowledge of healthcare delivery systems and managed care regulations, utilization management, case management, process improvement, and re-engineering processes, contract terms/stipulations, and government regulations also required.
• You have at least one-year previous management and leadership experience required.
• You are competent and Experienced with Utilization Management and Regulatory and Accrediting agency standards.

What we offer:

• 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

#IDCC

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.