Primary Perform:
The Director, Clinical Care management will work collaboratively with eviCore management, Nurse Reviewers, and Case Managers, appearing as a liaison to insure course of compliance and management for the onsite subject nurses.
Studies to: VP Clinical Care Management, PAC
Supervises: Sure
Location : Greenwich, CT workplace
Important Duties:
Duties embrace however will not be restricted to the next:
- Oversees and is answerable for the medical onsite UM and CM area employees
- Develops instructional packages for each inner and exterior clients on PAC from a medical perspective
- Assists in improvement of the annual UM Program Description, work plan and program
- Implements UM processes and workflows as a way to meet or exceed the requirements set by CMS, Accreditation our bodies, Shoppers, and relevant state regulatory necessities during which eviCore conducts enterprise
- Attends applicable committee conferences to disseminate and acquire pertinent info
- Initiates investigations for pressing high quality of care considerations
- Evaluations and analyzes every day, weekly, month-to-month reviews required to guarantee compliance to necessities on the employees member and division degree
- Screens CMS/DMERC tips for modifications in protection and for brand spanking new know-how protection and coordinates employees schooling as vital
- Successfully handles and resolves precedence points
- Delegates and screens work load assignments via Workforce Management and Logistics Supervisor to satisfy required timelines requirements and to handle referral and name volumes
- Works with departmental trainers to develop all coaching supplies, updates as wanted, making certain on-going medical accuracy
- Coordinates orientation of latest employees
- Teaching and mentoring for group leads/managers and new/present employees . .
- Supplies (at a minimal) weekly updates to supervisor
- Ensures compliance with eviCore insurance policies and procedures
- Demonstrates information and understanding of cultural competency and complies with privateness insurance policies and practices
- Performs different assignments to satisfy organizational wants inside the skilled scope
Place Qualifications:
o Lively, unrestricted license as Registered Nurse
o Licensed Case Supervisor (CCM) with Utilization Management expertise
o Managed Care/Medicare/Medicare Benefit information required
o Information of CMS tips for submit acute providers together with residence well being and DME
o Information of ICD diagnostic coding and CPT procedural coding, InterQual and CMS tips required
o Minimal 7years post- acute Facility, hospital and/or healthplan expertise
o Residence well being, SNF, and/or rehab expertise desired
o Medicare/Medicaid managed care packages most popular
o Management expertise, together with management of distant employees, required
o Time-management : Potential to successfully manages one’s time and assets to make sure that work is accomplished effectively
o Communication : Capability to offer clear verbal and written info by way of in-individual, e mail, and telephone to clients, co-staff, and management
o Important-Considering/Choice-making : Capability to decide on a plan of action or creating applicable options by figuring out and understanding points, issues, and alternatives
o Autonomy : Capacity to work independently with little to no supervision
o Intermediate pc literacy expertise with means to make use of and troubleshoot Microsoft Phrase, Excel, Outlook, and PowerPoint required
o Expertise utilizing videoconferencing techniques similar to WebEx
Work and Time Necessities:
- Place is situated within the Greenwich, CT workplace
- Place will probably be full-time throughout core enterprise hours
- Journey as wanted – minimal 25%
- Means to take a seat at a desk and make the most of the pc, phone, and different workplace gear, all through your complete work day
- Reliable and dependable work schedule is important
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