Utilization Review Manager - Home Care jobs in Bismarck, ND

Scope:

The Regional Clinical Manager is a licensed Registered Nurse who oversees a team of clinicians in all day-to-day aspects of client/family care including, but not limited to: regulatory and billing compliance, scheduling of adequate staff, Interdisciplinary Team (IDT) meetings and utilization, customer service, and the provision of medication, services, equipment and supplies, in accordance with the individualized plan of care developed by the client and/or family, physician and interdisciplinary team.

Key Responsibilities:

• Oversees the day-to-day clinical provision of services the Interdisciplinary Team (IDT) ensuring appropriate and timely care in compliance with corporate and home health policies, procedures, state, and federal regulations.
• Supervises field and office team members to achieve efficient quality client-centered care, meet productivity standards, and best practice team utilization to meet client/family, referral source and community expectations.
• Manages case load assignments based on acuity, team members, territories, and benchmarks.
• Collaborate with Quality and Compliance, Training and Education, and Human Resources to provide a strong orientation and expert clinical care, support the IDT, achieve, and retain adequate staffing.
• Works closely with Quality to remain updated with clinical outcomes, Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, Hospice compare and PEPPER data and create action plans to maintain or improve all scores.
• Works directly with Clinical Team Assistant to coordinate and manage hospice referrals. Will perform chart assessment to assist with determining hospice eligibility. Manages Face to Face scheduling and ensures documentation is completed timely. Manages Certifications of Terminal Illness.
• Maintain communication with the Hospice Medical Director and Hospice Physician Designees on a regular basis to communicate patient admissions.
• The duties and responsibilities listed above are representative of the nature and level of work assigned and are not necessarily all inclusive.

Education and Experience Required:

• Must be licensed as a Registered Nurse in the states of Minnesota and North Dakota.
• Bachelor’s degree is preferred.
• A minimum of one year of Hospice experience with Ethos is preferred.
• Must obtain CPR certification within 6 months from date of hire.
• Must have a valid driver’s license and use of an insured personal vehicle.
• Must complete and pass a state required background study.
• Able to communicate verbally and in writing to the extent required by the position.
• Able to physically perform the duties required by the position.
• Required to have the ability to read, write and speak English well enough to communicate with staff, patients, families and facilities.

Reports To: Director of Home Health & Hospice