Sr. Clinical Manager, Clinical Care Coordination

Integrated Home Care Services, Inc.•Miramar, FL

12h•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

Overseeing the referral management and prior authorization of DME services to ensure efficient resource utilization, medically necessary services, regulatory compliance, and exceptional patient care.
Reviewing clinical documentation, streamlining workflows, collaborating with interdisciplinary teams, and implementing utilization management strategies to enhance operational efficiency and cost-effectiveness.

Responsibilities

Plans, coordinates, and supervises the work of assigned staff, including recruitment, training, performance evaluations, compensation reviews, and disciplinary actions. Ensures team meets performance benchmarks related to productivity, accuracy, and compliance.
Allocates personnel and resources to meet objectives within budget and scheduling constraints while upholding high clinical standards. Oversees task and project management to ensure timely completion.
Directs unit activities to provide clinical support for services, product development, issue resolution, and the identification of new clinical opportunities. Tracks clinical performance metrics to drive improvements.
Leads training, procedural guidance, policy interpretation, and continuous coaching for Utilization Management staff. Drives department efficiency through process improvements, policy updates, and staff training in collaboration with leadership. Monitors staff adherence to training and compliance KPIs.
Manages interactions between IHCS and external stakeholders, addressing requests for program enhancements, inquiries, audits, compliance concerns, and other issues. Ensures timely resolution of stakeholder concerns while maintaining customer satisfaction and compliance with contractual obligations.
Oversees the review process for coverage and medical necessity requests, ensuring appropriate case referrals to the Medical Director in alignment with department protocols. Tracks case turnaround times and approval/denial rates to maintain compliance with established benchmarks.
Ensures accurate interpretation of medical policies and benefit plan descriptions, supervising staff responsible for making coverage determinations. Monitors policy adherence and accuracy in decision-making to meet compliance KPIs.
Facilitates timely communication with providers, agencies, and claims payers regarding authorizations, denials, and documentation requests, adhering to service agreements and performance expectations. Ensures resolution of provider concerns within established timeframes.
Maintains high productivity and quality standards, providing recommendations for system enhancements to improve efficiency and outcomes. Regularly reviews performance reports and trends to drive strategic improvements and ensure department meets KPIs related to efficiency, cost savings, and patient outcomes.
Safeguards patient confidentiality and ensures HIPAA compliance in accordance with company policies and procedures. Monitors adherence to privacy regulations and compliance training completion rates.