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Manager-utilization Mgmt/clinical Documentation

Company: Covenant Healthcare
Location: Saginaw
Posted on: June 1, 2021

Job Description:

Covenant HealthCare

US:MI:SAGINAW

8:00 AM - 4:30 PM, MONDAY - FRIDAY

FULL TIME BENEFITED

Summary:

The Clinical Manager of the Utilization Management and Clinical Documentation Improvement (UM/CDI) Department assists with overseeing the daily operations of the UN/CDI department. This position oversees the Utilization Review Nurses and Clinical Documentations Improvement Specialists. Utilization Management is responsible for ensuring compliance with regulatory requirements for the appropriateness and medical necessity of care provided. Clinical Documentation Improvement reviews the medical record to ensure accurate and complete clinical documentation, working with providers using a query-based system. The Manager provides the input to the Director of Revenue Cycle regarding daily strategic decisions that affect the functional areas of the department.

Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

Responsibilities:

  • Serves as immediate manager for Utilization Review and Clinical Documentation Improvement staff at the facility.
  • Responsible for daily operational management, supervision of staff, budget preparation and monitoring, and other management duties.
  • Accountable for strategic planning, implementation, evaluation, and revision of systems that support UM/CDI department and organizational goals.
  • Maintains 24-hour accountability for his/her area functions.
  • Assists with developing and implementing UM/CDI programs and daily scheduling of all staff.
  • Evaluates and assesses patient care data to ensure that care is provided in accordance with CMS Conditions of Participation and clinical guidelines by ensuring staff are using appropriate and Covenant HealthCare endorsed tools that meet organizational standards.
  • Responsible to provide leadership and direction in the daily operational activities of UM and CDI functions by assuring that activities are appropriately assigned, resources are available, and requirements of external entities such as regulatory and third-party payers are met.
  • Ensures that the department objectives and metrics are achieved timely and on-target according to identified goals, including the four pillars of success.
  • Communicates issues and concerns affecting the department's capacity to achieve results with the Revenue Cycle leadership and proactively assists with crafting solutions that will positively impact identified goals.
  • Assigns tasks according to priority and supports in carrying out activities to reach identified goals.
  • Ensures that department needs are identified, analyzed and responded to in a timely manner.
  • Responsible for final oversight of payroll, performance evaluations and corrective action.
  • Perform other duties as assigned.

Other information:

EDUCATION/EXPERIENCE REQUIREMENTS

  • Bachelor's Degree required.
  • Licensed RN in the State of Michigan required.
  • Minimum three (3) years of supervisory/management experience required.
  • Experience in Utilization Management and/or Clinical Documentation Improvement required.
  • Minimum of five (5) years of experience in a patient care acute setting preferred.

KNOWLEDGE/SKILLS/ABILITIES

  • Working knowledge of navigating patients through procedures and across the continuum of care.
  • Experience with continuous performance improvement preferred.
  • Ability to communicate effectively, both written and verbal communication, with persons of various cultural and educational backgrounds, including patients, families, staff, leadership and physicians.
  • Demonstrates knowledge of utilization review and clinical documentation improvement.
  • Maintains professional development through seminars, workshops, in-service activities and current professional literature
  • Excellent organizational skills and ability to effectively coordinate all aspects of patient care.
  • Ability to be an active, participatory member the interdisciplinary team.
  • May be required to participate in on-call activities after hours and weekends.
  • Full command (written and verbal) of the English language.

WORKING CONDITIONS/PHYSICAL DEMANDS

  • Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.
  • Frequent walking, sitting, talking, and hearing.
  • Occasional lifting, standing, carrying, pushing, pulling, climbing, stooping, reaching, handling, and fingering.
  • Occasional near vision, midrange vision, far vision, color vision, and field of vision.
  • Occasional lifting 0-50 lbs.

NOTICE REGARDING LATEX SENSITIVITY IN APPLICANTS FOR EMPLOYMENT.

It has been determined that Covenant HealthCare cannot provide a latex safe or latex free work environment at any of its facilities. Unfortunately, that means that any individual, including an applicant or an employee, is likely to be exposed to latex while on Covenant's premises. Therefore, latex tolerance is considered to be an essential function for any position with Covenant.

Keywords: Covenant Healthcare, Saginaw , Manager-utilization Mgmt/clinical Documentation, Other , Saginaw, Michigan

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