The CareCentrix Post-Acute Care program is a comprehensive offering that manages financial risk for the costs of care for 90-days after a patient’s discharge from the hospital. The program identifies the recommended site of-care for the patient, manages length of stay (LOS) if a Skilled Nursing Facility (SNF) is appropriate, and aims to reduce hospital readmissions. Our program also coordinates all of the services required for a patient to transition to their home faster and safer, by using home health, durable medical equipment and home infusion providers; all of whom are supported by our readmission reduction team.
This position provides oversight of the Post-Acute Care (PAC) Clinical Reviewer (clinical) and Care Coordinator (non-clinical) teams, performing a full range of functions: Intake, Phone, Faxing, Staffing and Medical Necessity Reviews for Skilled Nursing Facility
• Abides by and demonstrates the company Mission – Vision – Values through both behavior and job performance on a day-to-day basis.
• Convey a strong professional image, exhibit interest and positive attitude toward all assigned work.
• Candidate will possess excellent communication (verbal/written), organizational and interpersonal skills.
• Responsible for the day to day operations of the Post Acute Care Program and provides team leadership and guidance. Develops processes, tools and provides clinical oversight for clinical reviewers.
• Assists Product Development team in defining operational process and procedures and implements standardized operation processes to ensure compliance with CareCentrix policies, legal requirements and regulatory mandates.
• Supervises all daily team activities and 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. Completes performance reviews and mentors the PAC Supervisors and team members.
• Ensures the confidentiality of patient documentation. Provides guidance to staff in the record documentation process.
• When needed, trains new and existing team members. Participates in staff development, ensuring department activities are consistent with CareCentrix policies and procedures and contractual agreements.
• Functions as a clinical resource for the Post Acute Care (PAC) team.
• As appropriate, audits PAC cases and interventions to monitor outcomes, track/trend results and identify opportunities for process improvement.
• Monitors department reports and provides input for team and individual staff improvement opportunities that are in accordance with department and company goals.
• Sets deadlines and priorities in keeping with the PAC Program and Company goals.
• Participates in on-going CareCentrix quality assessment and performance/process improvement activities as assigned, and documents information enabling data collection and root cause analysis needed to identify opportunities for improvement.
• Performs all duties in a management role. Interacts with all CareCentrix departments, CareCentrix staff, providers, hospital staff, home health agencies, referral sources and health plans to facilitate communications, answer questions, and resolve problems. Encourages/fosters and environment of teamwork, communication, collaboration and readiness for change.
• Works with the Director of UM to implement best practices for utilization and authorization management of selected home care services. Works collaboratively with Provider Relations and provider network to achieve desired goals.
• Adheres to and participates in Company’s mandatory HIPAA privacy program / practices and Business Ethics and Compliance programs / practices. Ensures compliance with Utilization management NCQA and URAC standards.
• Participates in implementing / maintaining operational processes to ensure compliance to Company policies, legal requirements and regulatory mandates.
• Attends/participates 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.
• Manage multiple tasks, be detail oriented, be responsive, and demonstrate independent thought and critical thinking.
• Reviews and adheres to all Company policies and procedures and the Employee Handbook.
• Participates in special projects and performs other duties as assigned.
Registered Nurse actively licensed in their home state without restrictions is required. 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. At least one year previous management and leadership experience required. Competent and experienced with Utilization Management and Regulatory and Accrediting agency standards.
CareCentrix maintains a drug-free workplace in accordance with Florida’s Drug Free Workplace Law.