Utilization Workflow Manager

Graham Healthcare Group•Virtual PA, PA

9d•$70,000 - $90,000•Remote

About The Position

The Utilization Workflow Manager is responsible for analyzing patient data, and consistency of OASIS documentation, orders, and visit assessments. The reviews will focus on coding, OASIS accuracy, completion, and compliance with regulatory requirements and industry standards, applicable state/federal regulations, accreditation, and utilization standards to contribute to high quality clinical care and outcomes for the agency’s patients.

Requirements

OASIS and coding experience strongly preferred.
Self-directed with strong organization skills
Must be detailed oriented
Effective communication skills, verbal and written with leadership abilities
Must be able to work autonomously
Must be able to work in front a computer for long period to review documentation and workflow.
Minimum of two years’ experience in home health with experience in quality, supervisor, or staff development roles.
Licensed RN or PT in good standing from an accredited program required

Nice To Haves

HCHB experience preferred
ICD Coding/OASIS certification preferred

Responsibilities

Assures compliance with timeliness, accuracy, and content of clinical documentation in accordance with applicable regulations and industry standards.
Reviews clinician OASIS documentation and plan of care.
Approves plan of care to send to signing provider after verifying complete and relevant content, accuracy, orders, treatments, and discipline-specific goals and visit frequency that aligns with the referring provider documentation and in-home visit note.
Provides recommendations related to the plan of care and/or OASIS inconsistencies, omissions, and/or discrepancies with the available documentation in the chart, approved by the clinicians who completed the in-home visits.
Monitors OASIS lock of each event and completes workflow within the desired timeframe.
Evaluates and verifies appropriate visit frequency meets the needs of the patient and ordering provider and is supported by the plan of care in collaboration with the assessing clinician.
Recommends appropriate service utilization by discipline using HCHB tools and reports.
Utilizes SHP and other company provided analyzer tools and addresses alerts for clinical documentation improvements.
Collaborates with coding partners to complete timely OASIS workflow.
Obtains additional provider or facility patient records that may contribute to the accuracy of the plan of care or OASIS question.
Escalates opportunities for documentation improvement to the supervisor and other members of the leadership team.