Utilization Manager RN

Company: Residential Healthcare Group
Location: Downers Grove
Posted on: October 9, 2021

Job Description:

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Job Description

ESSENTIAL 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.

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Residential Home Health and Residential Hospice is an Equal Opportunity Employer

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