[Hiring] Utilization Workflow Manager @Graham Healthcare Group

Role Description

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.

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.

Qualifications

• Self-directed with strong organization skills
• Must be detail-oriented
• Effective communication skills, verbal and written with leadership abilities
• Must be able to work autonomously
• Must be able to work in front of a computer for long periods to review documentation and workflow

Requirements

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

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