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Salary: 83,343.00-125,034.00 USD

Facility: Administrative Regional Training Cntr

Shift: Shift 1

Status: Full Time FTE: 1.000000

Bargaining Unit: ACE Associates

Exempt from Overtime: Exempt: Yes

Work Schedule: Days

Hours:

M-F 7-3 or 8-4 with some evening and weekends coverage as needed

Summary:

The Middle Revenue Cycle - Clinical Supervisor, as an active member of the Middle Revenue Cycle and interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity. The Middle Revenue Cycle - Clinical Supervisor is responsible for training and mentoring Utilization Review, Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure the teams receive comprehensive education on policies, procedures, regulations, denials, and clinical criteria. The role provides guidance, support, and feedback to facilitate skill development and successful job performance. The supervisor also serves as a secondary review/escalation point for potential or unanswered provider queries. Is responsible for identifying areas of focus and necessary process refinement through report analysis. Leads Middle Revenue Cycle team in enacting process changes and measuring efficacy and impact of results. Serves as a resource for physicians and administration regarding issues related to the appropriateness of inpatient DRG assignment and Level of Care. Coordinates follow-up audits to ensure full compliance with regulatory requirements.

This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization of review processes is vital.

Responsibilities:

EDUCATION

+ Bachelor of Science Nursing (BSN) degree

+ Registered Nurse with a current New York State license

CERTIFICATION

+ Holds, or will obtain within one year of hire, Certified Clinical Documentation Specialist (CCDS)

+ Holds, or will obtain within two years of hire, Certified Case Manager (CCM), Preferred

+ Certification in a Nationally Recognized Utilization Review Criteria set is preferred

+ At least 1 years' experience in working with third party payers strongly preferred

+ Must maintain New York State RN license

EXPERIENCE

+ Minimum of eight (8) years of experience working in an Acute Care Hospital Setting

+ Minimum five (5) years of experience working within Utilization Review/Case Management/Clinical Documentation Integrity or

+ Minimum of two (2) years of experience managing professional clinical staff in the role of documentation review against a criteria set including but not limited to utilization review, Clinical Documentation Integrity, quality improvement or chart audit/review or

+ Minimum two (2) years of experience managing a professional clinical team with one of the major consultant firms

+ Proficiency in utilization management/clinical documentation Integrity and regulatory requirements required

+ Experience in working with people who are geographically dispersed

+ Proven success in implementing system-wide UM/CDI standardization

+ Proven ability to mentor and coach others effectively

KNOWELDGE, SKILL AND ABILITY

+ Ability to lead, challenge, motivate, coordinate and facilitate teams across the utilization management continuum

+ Understanding of clinical quality and utilization metrics used to design value-based contracts and measure performance in health care

+ Excellent interpersonal communication and networking skills to develop positive, productive and collegial working relationships with multiple internal /external stakeholders across the continuum

+ Excellent critical thinking skills, Actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from or generated by, observation, experience, reflection, reasoning or communication as a guide to action

+ Excellent knowledge of Microsoft office, word, excel and power point; Webex/Teams programs

+ Knowledge of Quality Improvement, Root Cause Analysis, CMS and Joint Commission regulations

+ Fosters trust and exchange of ideas across departments to innovate and hardwire highly reliable practices

+ Ability and skill to create a learning environment and foster growth

+ Ability to manage in complex and demanding contractual relationships

+ Analytic skills for detailed reporting, creating dashboards and interpretation

+ Effective decision maker - able to gather facts, assess all perspectives and weigh different possibilities to influence positive outcomes

+ Adaptability - maintain effectiveness when experiencing major changes in work tasks or the work environment, able to adapt to change in environment and/or circumstances with a positive outlook and adjusting effectively to work within the new processes

+ Proactively prioritizes initiatives, effectively manages resources and keen ability to multi-task

+ Initiative - independently takes prompt proactive steps towards problem resolution

+ Facilitation - ability to facilitate small and large groups of people at various organizational levels for purposes of planning, problem solving, strategic development and policy changes

+ Demonstrated understanding of complications, co-morbidities, severity of illness, risk of mortality

+ Knowledge of ICD-10, current knowledge of coding clinics including recent changes/updates, and understanding of the various DRG methodologies (AP-DRG and MS-DRG)

+ Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting.

+ Self-Confident personality traits to facilitate ongoing physician communication

+ Ability to relate well and establish partnerships with the providers to maximize the quality of documentation for Catholic Health patients

+ Ability to work independently in a time-oriented environment

ENVIRONMENT

+ Normal heat, light space, and safe working environment; typical of most office jobs

REQNUMBER: 42190