Utilization Manager RN

Company: Residential Healthcare Group
Location: Downers Grove
Posted on: November 22, 2021

Job Description:

Job Title -Utilization Manager RNLocationDowners Grove, IL, USAAdditional Location(s)Employee TypeEmployeeWorking Hours Per Week40Job DescriptionESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned as necessary.

• Provide supervision and direction for field staff and act as liaison between field and office staff.
• Monitor clinicians via HCHB reports
• Update Clinical Record on an ongoing basis as relates to communications, orders, re-hospitalizations, conflicts, etc.
• Evaluate and address customer concerns, including documentation and resolution.
• Communicate with sales personnel regarding customer issues that arise and may affect referral source relationships.
• Responsible for communication with clinicians and physicians when adult protective services referral required.
• Evaluate client episode to determine appropriateness of discharges versus recertification and initiation of orders as appropriate.
• Review and manage visit time exception requests.
• Review staff schedules to assure productivity, communicating with PSC of staff availability, as well as providing Clinical Manager with projected productivity for staff once/week. Obtains physician orders for field staff from physicians, laboratory results and resumption of care orders as needed.
  • -Responsible for direct management of the POD's Clinical Field Staff, assigning tasks and objectives, and establishing clear measurables for monitoring results versus objectives.
  • Responsible for the development and engagement of POD's Clinical Field Staff by fostering a motivating work environment that recognizes and rewards strong performance.
    • Review and Approve Orders, Evaluation Documentation and frequency of visits.
    • Reviews potential LUPA cases with ACD
    • Participates in staff meeting and in-services.
    • Distributes monthly staff meeting information to staff not attending.
    • Case conference with assigned field staff as required.
    • Perform annual performance evaluations on field staff.
    • Works with clinicians in developing the patient frequency of visits that are clinically appropriate.
    • Assists agency personnel in care coordination of patient/client services. Serves as a liaison between the organization, referral sources, and patient/clients.
    • Assists in education of staff regarding hospitalizations.
    • Proficient in HCHB and Outlook.
    • Maintains Medicare guidelines regarding consents, ABN, non-provider coverage forms.
    • Participates in ongoing education.All other duties as assigned.NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.By supplying your phone number, you agree to receive communication via phone or text.Residential Home Health and Residential Hospice is an Equal Opportunity Employer

Keywords: Residential Healthcare Group, Downers Grove , Utilization Manager RN, Healthcare , Downers Grove, Illinois