DME Utilization Management Clinical Supervisor
Where
- Walnut Creek, CA
What you'll be doing
- Coordinates with physicians, staff, vendors and DME staff regarding utilization of DME. Manages the performance of a team DME clerks insuring quality, timeliness and accuracy of work. Responsible for the utilization review and completion of the NONC letters as per the appropriate regulatory guidelines to include but not limited to DMHC, NCQA, medicare and medical. Plans, develops, assesses, and evaluates ongoing DME services provided to members. Accountable for the performance of a team of 6-15 DME clerks. This includes oversight and tracking of utilization of ordered item/equipment to ensure quality, timeliness and accuracy of orders placed. Evaluates the individual performance of their team members including written annual performance appraisals. In conjunction with manager and administrative supervisor assists with the adjustment of the workflow for their teams of DME clerks. Prioritizes workflow in order to insure timely clinical review of requests, and timely completion of NONC letters within regulated time frames. Medical record review as necessary to ascertain additional information necessary for completion of referral for ordering or for UM review for denial. Confers with regional consultants over any clinical issues in which a question or problem arises. Maintains working knowledge of all coverage criteria and DME formulary guidelines. Responsible for the utilization management/reauthorization and tracking of equipment for example: oxygen, wound vacs, wheelchairs, breast pumps, dyna splints, and/or any other regional review initiative. And/or any other regional review initiative. Promotes/improves member client services by problem solving of member, clinician and provider complaints and or grievances. Must have demonstrated history of excellent service skills exhibited by courtesy, cooperative spirit and tact when interacting with patients, families and staff. Consistently supports compliance and the principles of responsibility by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements, and the policies and procedures of the company.
What your background should be
- Demonstrated experience in utilization management, discharge planning, or transfer coordination. Computer skills and experience with performance improvement projects and planning, coordinating and implementing programs required. Previous case management experience preferred. Graduate of an accredited school of nursing. Maintains current california RN licensure. Knowledge of nurse practice act, TJC, and other federal/state/local regulations. Ability to communicate verbally and in writing clearly and accurately. Must be able to work in a labor/management partnership environment.
Required Schooling / Training
- Bachelor degree, or equivalent experience, in nursing or health related field. Master degree preferred.
Who is the client company
- This is an integrated managed care consortium.
- If you are interested in this position, send your resume to apply@kochdavis.com
