Utilization Workflow Manager

Job Title 

Location

Additional Location(s)

Employee Type

Working Hours Per Week

SUMMARY:    

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.

UTILIZATION WORKFLOW MANAGER ESSENTIAL DUTIES AND RESPONSIBILITIES:

OASIS and Plan of Care Workflow: 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.

Utilization Management: 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.

Liaison: 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.

UTILIZATION WORKFLOW MANAGER

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

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.

EDUCATION and/or EXPERIENCE:

• 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

• HCHB experience preferred

• ICD Coding/OASIS certification preferred

CERTIFICATES, LICENSES, REGISTRATIONS:

 Must have and maintain in good standing professional license, certificate, or registration.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The job role requires being in front of a computer and must be able to sit for long periods of time. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

COMMENTS:

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

ABOUT GRAHAM HEALTHCARE GROUP:

As an innovator in an evolving healthcare world, Graham Healthcare Group has been designing business and technology solutions to drive better care, outcomes, and productivity within its own home health and hospice companies for over 20 years. In the last several years, our solutions have been successfully integrated across the healthcare continuum.

Join the Graham Healthcare Group and enjoy the following benefits:

• Competitive Pay:  With opportunity for advancement 

• Health and Welfare Benefits:  Various medical, dental, and vision insurance options for you and your family to choose from. 

• Supplemental Benefits: Company paid life insurance and disability benefits.  Also, pre-tax FSA and HSA plans are offered. 

• Generous PTO Packages.

• Retirement:  Save for your future with our company offered 401k plan and pension.

• Company-Paid Education Programs:  Grow your career by taking advantage of 50% discounts on tuition for selected courses offered by Purdue and Kaplan. 

Benefits may vary based on your employment status.

NOTICE:

• Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
• By supplying your phone number, you agree to receive communication via phone or text.
• By submitting your application, you are confirming that you are legally authorized to work in the United States.

Graham Healthcare Group is an Equal Opportunity Employer