Utilization Review Manager - Home Care jobs in Nashville, TN

Summary

Located in Franklin, Tennessee, Williamson Health is one of the South’s most exceptional health care systems with a 203 bed hospital (Williamson Medical Center), over 40 providers at our Williamson Health Medical Group locations, the Bone & Joint Institute and the Monroe Carell Junior Children’s Hospital Vanderbilt at Williamson Medical Center.  Williamson Health offers comprehensive in-patient and out-patient services. We have more than 825 providers representing over 70 medical specialties and sub-specialties. 

Williamson Health is a system where your talents will be valued and your skillset expanded. We are rooted in our promise to world-class, compassionate care for the residents of Williamson County and surrounding communities, taking exceptional pride in serving our community. We’re committed to empowering our employees to work in innovative ways and reserve time and space for curiosity, laughter and creativity. We value and support the diversity and cultural differences among one another and are committed to upholding an inclusive environment that appreciates the uniqueness of all individuals. Our values are at the heart of everything we do: respect for every individual, the health and total well-being of all people, human compassion and integrity. These shape who we are as an organization and are essential for delivering the highest level of culturally competent care and treatment of every patient, family member, visitor, physician and employee.

Williamson Health is pleased to offer a comprehensive benefits program, that offers you choice and flexibility, so you can take charge of your physical, financial, and emotional well-being. 
o    Medical, Dental, Vision
o    PTO
o    Retirement Matching
o    Tuition reimbursement
o    Discount programs
o    FSA (Flexible Spending Accounts)
o    Identity Theft Protection
o    Legal Aid

Williamson Health is an equal-opportunity employer and a drug-free workplace.

POSITION SUMMARY

Responsible for daily management and oversight of the following departments: Test and Surgery Scheduling, Worker’s Compensation and Utilization Review. Assists the Director of Operations as directed and needed. For purposes of evaluations and attendance, this position reports to the Director of Operations.

POSITION REQUIREMENTS

Formal Education/Training:
Bachelor’s Degree preferred in Business, Healthcare Administration or related field; or equivalent experience.

Workplace Experience:
At least three years of supervisor or higher experience in a medical practice. Billing/collections, front and back-office procedures/policies experience preferred. Demonstrate leadership and good interpersonal skills.

Equipment and Skills Training:
Strong Computer Skills, Communication and Presentation Skills required. Demonstrated ability to self-direct, meet deadlines and support Physician Groups.

Physical Environment:
Physician and Clinical setting/environment.

Physical Effort:
Requires the ability to communicate proficiently; oral and written. Requires prolonged standing and working up to twelve hours if needed. Requires the ability to lift minimal amounts (20-25 lbs).

PERFORMANCE STANDARDS

1. Maintains administrative functions for Test and Surgery Scheduling, Worker’s Compensation and Utilization Review department operations and assists in organizing departmental, interdepartmental, and other meetings/events as needed.
2. Facilitates staff development, assists with the orientation and training of new department personnel, ongoing educational programs, regularly scheduled touchpoints, and staff evaluations (90 day and annual).
3. Acts as liaison to support staff and patients by responding to assistance needs; including working in departments to cover vacations/absences when needed or requested by the Director of Operations.
4. Serves as principal contact for clinic staff regarding prior authorization processes for services to be rendered by BJIT providers, by maintaining a current knowledge base related to insurance requirements for prior authorization.
5. Develop procedures for prior authorization and denial management functions.
6. Serves as liaison between BJIT surgeons and outside surgical facilities.
7. Maintains accurate and appropriate payroll reporting and staff scheduling for all direct reports, including reviewing incoming employee applications and position postings. Arranges interviews in conjunction with HR in order to hire new employees as needed.
8. Improves performance with regard to patient/employee satisfaction scores. Consistently meets or exceeds KPI’s set for assigned departments.
9. Reports completely and accurately any incident that may warrant review by manager/physician.
10. Maintains open line of communication with all staff members; interacts with staff/patients in a professional and constructive manner.
11. Reports concerns requiring attention to other managers or Director of Operations. Employee is a problem solver that brings possible solutions when presenting concerns or problems and responds to patient/staff complaints in a timely manner.
12. Participates in departmental meetings/huddles/etc. and recommends improvement opportunities. Performs other duties as assigned by Director of Operations.