Utilization Management Director jobs in Columbia, SC

The Director of Case Management is responsible for coordinating medical services to achieve excellence in clinical outcomes, patient experience, and cost containment in accordance with best practices and nationally accepted standards of care. The Director of Case Management will support a culture of compliance with all applicable federal and state regulations. This position works closely and collaboratively with the members of the care group and with regional leadership.

This is a salary based position. Schedule: 8am-5pm (Monday-Friday)

AREAS OF RESPONSIBILITY

A successful Director of Case Management will be able to perform these essential duties and responsibilities. Reasonable accommodations may be made, in accordance with applicable law, to enable individuals with disabilities to perform the essential functions.

Duties:

• Continuous education, training, and Athena Care Coaching to advance professional skill sets.
• A coaching culture and participates in conference calls, TEAMS meetings, webinars, etc
• Additional coaching, education, and positive reinforcement, and enlists our team talent to assist in addressing opportunities in a timely manner for optimal performance.
• Assist providers to optimize outcomes by coaching for best practices including documentation, medication reconciliation, deprescribing, timely closing of notes, and hosting advanced care planning.
• Provide SC House Calls a return on investment and be a quality steward of company funds.
• Must be available during normal work hours (unless previously approved by direct supervisor). Additional hours may be required to complete normal business functions and/or projects.
• Utilize the company’s software systems and update information as required.
• Participate in coaching calls.
• Perform other duties as requested or required, in the sole discretion of SC House Calls.
• All resources engaged in the team-based care of each patient, including but not limited to the visiting practitioner, quality provider, specialist, cognitive behavioral therapist, dietitian, pain interventionalist, pharmacist, medical social worker, and support team including the Regional Lead Coder, Regional Director of Training and Education, Regional Staffing Coordinator, etc.
• All medical providers including pharmacists assigned to the care group related to visits, CCM utilization, quality measures, annual wellness visits, patient experience, and quality scores.
• Hospice, home health, skilled nursing and assisted living teams to develop person-centered interprofessional team coordinated plans of care.
• Regional team by participation in dinners, gatherings, meetings, etc. to communicate goals, and values, report on the progress toward those goals, provide direction & guidance to achieve the goals and report on trends within our healthcare system and industry to promote team momentum, enthusiasm, and pride in an ever-evolving environment.
• Facilitate proficiency in documenting patient information & timely closing of encounters.
• Ensure AWVs are completed ASAP and within the first three quarters.
• Promote effective, efficient, and accurate documentation on all diagnoses, at the highest specificity, to produce the correct risk adjustment factor accurately reflecting clinical complexity and morbidity.
• Promote effective, efficient, and accurate in capturing frailty and all advanced illness.
• Schedule GAP-IN-CARE and Quality Metric visits in a timely manner
• Deliver appropriate medical care through medically necessary visits by the optimal resource
• Advance proactive medical care and mitigation of negative outcomes by ensuring encounters as appropriate, but no less than every 60 days.
• Facilitate excellence in “Patient Experience” as reported by the assigned provider
• Provide the necessary coaching, new user or remedial training, and ongoing support.
• Communicates best practices, clinical workflows, goals, operational processes, policies and procedures, regulatory requirements, and the value of our program to the regional team.
• Works collaboratively and communicates effectively with administration, and clinical care teams through participation in the planning, development, evaluation, and maintenance of the clinical information system.
• Implement DAX (dictation software) for all assigned providers.
• Actively engages in the development, implementation, and evaluation of the healthcare system quality improvement program.
• Identifies opportunities for improvement, recommends solutions, and coordinates/participates in the development and implementation of process improvement action plans to improve efficiencies and contribute to desired outcomes.
• Resolves problems and recommends solutions through research, inquiry, and data analysis, maintaining support and tracking of issues.
• Ensure visit frequency aligns with best practice, medical necessity, and person-centered care.
• Identify and adopt excellent protocols to reduce variability across the continuum to improve quality outcomes.
• Work with care group to prevent hospitalizations through patient touches, and monitor hospitalizations that do occur and intervene accordingly.
• Monitor regional workflow dashboard and clinical buckets to ensure tasks are being completed timely.

QUALIFICATIONS

• RN License must be in good standing with South Carolina Board of Nursing.
• Physician services and management experience required.
• A minimum of three (3) years experience in healthcare setting required.
• Demonstrated ability to supervise and direct professional and administrative personnel.
• Ability to read and communicate effectively.
• Strong written and verbal skills.
• Basic computer knowledge.
• Ability to manage and demonstrate effective leadership skills.
• Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
• Ability to foster a cooperative work environment.
• Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
• Must be able to work flexible hours and travel between offices, facilities, etc. Must be a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order.

As an employee of Your Health, you will be part of an established and highly regarded faith-based company committed to your personal and professional development that offers:

• Competitive compensation
• Health Savings Account w/ "dollar for dollar" match up to $1,050.00
• 401(k) w/ company match up to 4% of gross annual salary
• Career advancement through education and nationally recognized apprenticeship opportunities
• Comprehensive health, dental and vision coverage
• Company sponsored life insurance coverage
• Other incentives include a pay per visit, monthly bonus, and a car package benefit.

If you are a driven individual with a passion for Health Care Leadership, we invite you to apply for this position. Join our team and make a significant impact on the success and growth of our organization.

For more information about Your Health Organization, please visit our website at: www.yourhealth.org