Utilization Management Director jobs in Aiken, SC

JOB TITLE: DIRECTOR OF CASE MANAGEMENT

REPORTS TO: VP OF Population Health

CATEGORY: EXEMPT

GENERAL DESCRIPTION

The role of the Director of Case Management is responsible for ensuring a smooth registration process for new patients and efficient appointment scheduling for new and existing patients. The Director of Case Management will be responsible for overseeing and coordinating appointments between patients and appropriate healthcare providers in accordance with the Company’s policies and procedures, maintain accurate records, and providing exceptional customer service.

AREAS OF RESPONSIBILITY

A successful Case Manager will be able to perform these essential duties and responsibilities. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.

The following is a list of essential functions, which may be subject to change at any time and without notice. Management may assign new duties, reassign existing duties, and/or eliminate function(s).

• Appointment Scheduling: Schedule appointments for patients with healthcare providers based on availability, medical urgency, and patient preferences. Ensure all providers (which includes pharmacists, medical social workers, etc.), nurses, medical professionals, etc. schedules are fully optimized.
• Patient Communication: Interact with patients via email, patient portal, telephone, text, in person, etc. to gather necessary information, schedule and confirm appointments, and provide pre-appointment instructions. Respond to patient inquiries, resolve scheduling conflicts, and assist in rescheduling appointments when necessary.
• Records Management: Maintain accurate and up-to-date patient records, including demographic information, contact details, insurance information, appointment history, etc. Ensure confidentiality and adhere to privacy regulations when handling sensitive patient information.
• Coordination with Healthcare Providers and Staff: Collaborate closely with Care Team members (healthcare providers, nurses, clinical coordinators) and other staff members to ensure optimal scheduling and coordination of patient care. Communicate changes, cancellations, or rescheduling of appointments to relevant parties in a timely manner. Communicate with providers and staff via phone, email, Teams, Athena or in person.
• Insurance Verification: Verify insurance coverage and eligibility for patients ensuring accurate documentation of insurance information at all times. Collaborate with the billing department to address any insurance-related issues or concerns.
• Workflow Optimization: Continuously assess and improve appointment scheduling processes to enhance office efficiency and productivity. Identify areas for improvement and propose solutions to streamline operations.
• Customer Service: Provide exceptional customer service to patients, exhibiting a compassionate and empathetic attitude. Address patient concerns, inquires, and complaints professionally and promptly, striving to meet patient needs and ensure their satisfaction.
• Administrative Functions: Perform general administrative tasks and support other staff as needed. Work assigned buckets, ticklers, census lists, and region’s scheduling voicemail tasks. Utilize the company’s software systems to enhance patient care and staff productivity.
• Collaboration and Coordination: Collaborate with internal and external resources to facilitate and ensure seamless operations.
• Participate in coaching calls.
• Perform other duties as requested or required, in the sole discretion of the Company.

MISSION EXPECTATIONS

• Take responsibility for own work in completing tasks. Assist others so that the resources, assistance or support is provided to achieve success in their daily work.
• Communicate, endorse, and demonstrate the Company’s mission, vision and values.
• Prompt and regular attendance.

2

• Adhere to standards of behavior, dress code including name tag and approved uniform, personnel department and company policies.
• Attend in-services and meetings on a regular basis.
• Promote a culture of outstanding customer service at all times.
• Must be available during normal work hours (unless previously approved by direct supervisor). Additional hours may be required to complete normal business functions and/or projects.
• Must possess the ability to deal tactfully with patients, employees, management, visitors, government agencies, and the general public and maintain an open-door policy for all employees.
• Must possess the ability to make independent decisions when circumstances warrant.

WORK ENVIRONMENT

The work environment characteristics described herein are representative of those an employee encounters while performing the essential functions of the job:

• May be exposed to housekeeping cleaning agents and chemicals, humidity, hot equipment, and/or noise.
• May be exposed to infections, communicable diseases, odors, bloodborne pathogens, excreta and hazardous materials.

COMPLIANCE WITH POLICIES AND PROCEDURES

• Comply with all federal, state and local laws and regulations.
• Knowledge of and compliance with Patient’s Bill of Rights.
• Must be knowledgeable of Medicare guidelines, applicable laws and regulations, and the Company’s policies and procedures.
• Adhere to the Company’s Code of Conduct / Ethics.
• Must exercise a high degree of confidentiality regarding patients, personnel and the Company.
• HIPAA compliant.
• Promote a culture of compliance.

Job Type: Full-time

Pay: $65,000.00 - $75,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Relocation assistance
• Tuition reimbursement
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Supplemental pay types:

• Bonus opportunities

Education:

• Bachelor's (Required)

License/Certification:

• RN License (Required)

Work Location: In person