FULL TIME BENEFITED
Assist the manager in strategic planning, implementation, evaluation, and revision of systems that support the UM/CDI Department and organizational goals.
Provides education for the UM staff to keep them current with changes in regulations and CMS GuidelinesEvaluates and assesses patient care data to ensure that care is provided in accordance with CMS Conditions of Participation and clinical guidelines by ensuring staff are using appropriate and Covenant HealthCare-endorsed tools that meet organizational standards. Provide leadership and direction in the daily operational activities of UM by assuring that activities are appropriately assigned, resources are available, and requirements of external entities such as regulatory and third-party payers are met. Ensures that the department objectives and metrics are achieved timely and on-target according to identified goals, including the four pillars of success. Communicates issues and concerns affecting the department's capacity to achieve results with the Revenue Cycle leadership and proactively and assists with crafting solutions that will positively impact identified goals. Assigns tasks according to priority and supports in carrying out activities to reach identified goals. Ensures that department needs are identified, analyzed and responded to in a timely manner.
Ensure processes followed for: All Medicare medical inpatient and observation patients that do not meet inpatient criteria will follow the EHR referral process guidelines. Actively monitor process with weekly and monthly reports.
All Medicare surgical patients that are: listed outpatient when the procedure is normally done as inpatient, does not meet inpatient criteria, an outpatient procedure that stays overnight, or if there is evidence of event, complication, or comorbidity that does not meet inpatient criteria, Medicare re-admissions if questioning the “same episode of care” within 30 days.
Medicare continued stay reviews that no longer meet inpatient criteria, will follow the EHR referral process guidelines.
Other Duties as assigned.
Licensed RN in the State of Michigan required.
Utilization Management Experience requiredSupervisory/management experience strongly preferred. Minimum of five (5) years of experience in a patient care acute setting. KNOWLEDGE/SKILLS/ABILITIES Working knowledge of navigating patients through procedures and across the continuum of care. Experience with continuous performance improvement preferred. Ability to communicate effectively, both written and verbal communication, with persons of various cultural and educational backgrounds, including patients, families, staff, leadership and physicians.
Strong background in Utilization Management, including experience with InterQual and Indicia is preferred.
Knowledge of various payers preferredMaintains professional development through seminars, workshops, in-service activities and current professional literature. Excellent organizational skills and ability to effectively coordinate all aspects of patientcare. Ability to be an active, participatory member the interdisciplinary team. May be required to participate in on-call activities after hours and weekends Full command (verbal and written) of the English language. WORKING CONDITIONS/PHYSICAL DEMANDS Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards. Frequent walking. sitting. talking and hearing. Occasional lifting 0-50 lbs., standing, carrying, pushing, pulling, climbing and stooping, reaching, handling, and fingering, near, midrange and far vision, and color and field of vision.
NOTICE REGARDING LATEX SENSITIVITY IN APPLICANTS FOR EMPLOYMENT.
It has been determined that Covenant HealthCare cannot provide a latex safe or latex free work environment at any of its facilities. Unfortunately, that means that any individual, including an applicant or an employee, is likely to be exposed to latex while on Covenant's premises. Therefore, latex tolerance is considered to be an essential function for any position with Covenant.
Apply on company website