For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm)
The Supervisor, Case Management Services (Inpatient) is responsible for the supervision, evaluation and direction of the Utilization Compliance and Quality Management process. The position will ensure compliance with the case management program for prospective, concurrent, retrospective and transition to out-patient care coordinating with physicians, hospitals and
ancillary care and empowers team members through active problem solving and resource direction. The position is a resource for difficult or complex case management or discharge planning. The supervisor successfully impacts assigned team and organization by mentoring. In addition, the Supervisor, Case Management Services is responsible for timely completion of documentation audits, and reviewing and mentoring team members to meet and exceed all documentation and compliance standards. This position mentors and trains Inpatient Case Managers in the completion of admission request, release of pends and timely, accurate monthly
reconciliation reports and statistics and functions as an advisor to Physicians and lower level utilization management staff.
Monitors employees for excessive work and inability to complete position responsibilities within a normal workday and provide time management advice to employees
Takes ownership of the total work process and provides constructive information to minimize problems, increase customer satisfaction and improve job efficiency. Makes suggestions to appropriate managers as well as participates in the budgeting process by informing the manager of capital and operating needs
Maintains and stores supplies and equipment in a safe manner to eliminate/reduce safety risks
Strives to personally expand working knowledge of all aspects of WellMed departments.
Attends educational offerings to keep abreast of changes and comply with licensing requirements
Conducts annual evaluations of team members in a timely basis; provides feedback in a constructive manner and respects the confidentiality of personnel issues
Participates in UM/quality improvement committees and conducts special UM/QI studies as necessary
Liaison to market providers for UM providers
Fosters discharge plan collaboration with patient/family, attending physician and facility Case Manager
Performs all duties to customers in a prompt, pleasant, professional and responsible manner regardless of the stressful nature of the situation and always identifies self by name and title
Guides and answers benefit questions, contract issues, and updates physicians/medical groups of preferred contracts, providers, facilities and hospital utilization and noncompliance issues
Completes Case Management Documentation System (CMDS) audits on a monthly basis to maintain CMDS entry, compliance with bed, day, and financial responsibility information on in-patient admissions
Educates medical services personnel regarding utilization management policies, procedures and techniques
Oversees case managers and ensures compliance with approved standardized guidelines, regulatory requirements and contractual agreements while respecting the confidentiality of these agreements.
Demonstrates thorough knowledge of health plan benefits and quality of care criteria of health plan as well keeping abreast and compliance with established and all new or revised policies and procedures when posted or distributed with accurate interpretation to customers
Professional Nursing Degree with current RN License (in state of employment)
BSN or Associate's Degree or Diploma (from an accredited program) in Nursing
5 years experience in medical or ICU hospital based nursing or case management, discharge planning, utilization review or other cost containment role
Minimum of one year supervisory, team leader, or charge nurse experience, or one year successful case management experience with UHG/WellMed
Knowledge of the managed care referral process, case management, claims, contracting, and physician practice
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diptheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease
Medicare criteria knowledge preferred
Sound knowledge of NCQA and federal regulations
Must possess strong critical thinking, written and verbal interpersonal communication skills with ability to interact with professional and non-professional staff regarding healthcare issues
Careers with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000 lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: RN, RN Supervisor, Case Manager, RN Case Manager
Unitedhealth Group Inc.