Manager of Clinical Care Coordination, DME Respiratory

Integrated Home Care Services, Inc.•Miramar, FL

15h•Onsite

About The Position

IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1. With over 15 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you! Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care.

Requirements

Passionate about inspiring, motivating, and leading teams.

Responsibilities

Provides leadership, direction, and oversight to Clinical Care Coordination and Utilization Management staff supporting DME services.
Responsible for recruitment, onboarding, training, performance management, coaching, disciplinary actions, and compensation reviews.
Ensures staff consistently meet productivity, quality, compliance, and turnaround time benchmarks.
Oversees clinical review and authorization workflows for DME respiratory services, including CPAP, BiPAP, non-invasive ventilation, and invasive ventilators.
Ensures clinical documentation supports medical necessity, appropriate level of care, and alignment with evidence-based guidelines and payer requirements.
Directs utilization management activities to ensure timely UM reviews and determinations in accordance with CMS, state, and contractual turnaround time requirements for urgent and standard requests.
Monitors TAT performance, escalates risks, and implements corrective actions to maintain compliance.
Ensures accurate application of medical policies, benefit plans, and clinical criteria when making coverage determinations.
Oversees appropriate referral of complex or non-standard cases to the Medical Director in accordance with departmental protocols.
Monitors approval, denial, and overturn rates to ensure defensible, compliant decisions.
Allocates staff and resources to meet operational demands while maintaining clinical quality and regulatory compliance.
Oversees workload distribution, staffing models, and workflow optimization to support timely service delivery within budgetary constraints.
Leads ongoing training and competency development for UM and care coordination staff, including CMS regulations, medical necessity criteria, documentation standards, and DME-specific requirements.
Ensures adherence to policies, procedures, and compliance KPIs through audits, coaching, and continuous education.
Facilitates effective communication with providers, DME vendors, home health agencies, and payers regarding authorizations, denials, documentation requests, and care coordination needs.
Ensures provider inquiries and disputes are resolved within established service level agreements (SLAs).
Analyzes productivity, quality, cost, denial, and TAT reports to identify trends and improvement opportunities.
Leads performance improvement initiatives to enhance efficiency, reduce avoidable denials, support cost containment, and improve patient outcomes.
Ensures departmental compliance with CMS regulations, accreditation standards (NCQA, URAC, as applicable), internal policies, and contractual requirements.
Supports audits, regulatory reviews, and corrective action plans as needed.
Maintains strict adherence to HIPAA and privacy regulations.
Ensures staff compliance with confidentiality standards and completion of all required compliance and privacy training.