Utilization Management Supervisor

UPMC•Altoona, PA

8d•Hybrid

About The Position

Responsible for the development and ongoing daily activities of the UM staff within the organization. Provides oversight of OASIS documentation accuracy to ensure positive clinical and reimbursement outcomes. This position is mostly remote, but the candidate will need to live near a UPMC facility for training and meeting new hires on site.

Requirements

Graduate of an accredited nursing program. Licensed as Registered Nurse by the Pennsylvania State Board of Nursing.
Graduate of a physical therapy education program approved by the Commission on Accreditation in Physical Therapy Education (CAPTE or APTA). Licensed through examination by the Pennsylvania State Board of Physical Therapy.
Graduate of an Occupational Therapy Program, which meets the requirements of the Accreditation Council for Occupation Therapy Education, (ACOTE) of the AOTA and be licensed through examination by the state Board of Occupational Therapy.
Graduate at a Master's level which meets education requirements for a Certificate of Clinical Compliance (CCC) in Speech Pathology or Audiology or meets the education requirements for certification and is in the process of accumulating the supervised experiences required by Certification.
Minimum 3 years home health experience Required
ICD coding certification Required within a year
OASIS certification Required within a year
Demonstrated knowledge of Medicare, Medicaid and commercial insurance reimbursement as well as Conditions of Participation Required
Current licensure as a professional RN in the Commonwealth of PA? Required, or OT, or PT, or SLP
Current CPR certification Required
Current PA driver's license Required
Current auto insurance in state of residence Required
Act 34
Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.

Nice To Haves

Baccalaureate degree Preferred
Minimum 2 years management experience Preferred
Minimum 2 years Utilization Management experience - Preferred

Responsibilities

Directs and provides education to all UM Professionals regarding the assessment of patients and the establishment of a plan of treatment at the start of care and reimbursement issues including complex reimbursement system and individual payor home care eligibility requirements.
Serves as the OASIS resource/educator and oversees OASIS compliance and competencies.
Educates, reviews and supervises ICD-10 code assignments, completion of 485’s/POC, OASIS assessment completion and corrections, and complies with end of month deadlines.
Focuses on customer service and continually strives to perform the duties of their job in a manner that will result in optimal patient satisfaction.
Support staff to obtain and maintain ICD coding and OASIS certifications.
Conduct a comprehensive review and analysis of the patient's Plan of Treatment using standard tools and guidelines.
Responsible for the continuous performance monitoring appraisals for staff and is responsible for overseeing ongoing performance issues.
Performs interviewing, hiring, payroll and other employee related activities.
Compile and analysis productivity of UM professionals to ensure timely review and distribution of workload.
Gathers and disseminates information to appropriate personnel in order to enhance OASIS accuracy and the achievement of positive clinical and financial outcomes.
Participates as a member of agency committees.
Attends compliance training and adhere to the organization's standards of conduct, policies and procedures.
Performs in accordance with system-wide competencies/behaviors.
Performs other duties as assigned.
Assists in the development, coordination and facilitation of the orientation plan for all employees and yearly education and mandatory competencies.
Performs duties and job responsibilities in a fashion which coincides with the service management philosophy of the organization towards patients, visitors, staff, peers, physicians and other departments within the organization.
Identifies, develops and participates in process improvement opportunities within the home health organization that will enhance the quality of services we provide.