Supervisor, Physician Review Services Health Integrated
THIS JOB HAS EXPIRED Description
Position is based in Tampa, FL Hours: Monday - Friday, 9:00 am - 6:00 pm
JOB SUMMARY: The Physician Review Services Supervisor is responsible for the day to day operation of the PRS department. The position responsibilities include the management of all PRS Clinical and Non Clinical staff, liaison with other departments, including but not limited to: Account Management, Information Technology, Quality Improvement, Utilization Management, Implementation, and Case Management. Additionally, the Physician Review Services Supervisor works closely with each client to ensure effective implementation and problem resolution.
Licensed Clinical Social Worker (Master Level) or Registered Nurse with current, unrestricted license to practice as a health professional in a state or territory of the United States required. Upon hire or transfer will be expected to obtain licensure in states where Health Integrated conducts business, (equivalent with four to five years Utilization Management experience, supervisor/management experience in an inpatient and/or outpatient setting).
Experience: A minimum of two years experience in utilization review in a managed care environment and/or a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. One to two years directly related experience using nationally recognized criteria or other healthcare criteria preferred. Experience with medical and behavioral health preferred. Managed care and/or utilization management experience strongly preferred. Previous experience in a call center environment is highly beneficial.
Strong communication, documentation, clinical and critical thinking skills essential. Working knowledge of managed care or case management procedures preferred. Strong problem solving and decision-making skills essential. Strong typing and computer skills are essential. Strong leadership skills required. Call center knowledge desirable.
Contributes to PRS program goals and objectives in containing health care costs and maintaining a high quality medical delivery system through the program procedures for conducting PRS/UM activities;
Oversees telephonic and medical record reviews for inpatient and outpatient services using nationally recognized criteria or HI behavioral health criteria;
Ensures the collection of pertinent clinical information and documentation of all PRS review information.
Communicates directly with physician providers/designees when appropriate.
Oversees PRS processes to ensure compliance with regulatory standards and contractual requirements.
Ensures the timely reporting and documentation of all quality concerns to the Sr. Manager, PRS and Medical Director, per policy and procedure.
Ensures staff education and compliance regarding all HIPAA policies and procedures.
Communicates with providers regarding program requirements and problem resolution, as required.
Respond to client inquiries and work with them to resolve any performance issues.
Provide ongoing staff education and training related to work flow, contractual requirements, and updates to existing policies and procedures.
Interviews and hires PRS staff, as needed.
Counsels? employees, designs corrective action plans, and takes any disciplinary action that may be required.
Monitor telephone response times on an ongoing basis to ensure compliance with NMIS standards.
Maintains PRS logs and reports requested by Sr. Manager, PRS, Account Management and the Director of Quality on a Weekly/Monthly basis.
Participate in Interdepartmental meetings as required.
Identifies and communicates to the Sr. Manager, PRS all hospital, ancillary provider, physician provider and physician office concerns and issues;
Maintains courteous, professional attitude when working with HI staff, hospital and physician providers, and health plan client;
Identifies and communicates to health plan client and/or contracted ancillary providers all catastrophic and high risk cases for case management referral;
Monitors call volume and ensures calls standards are met by assigning or re-assigning staff as needed
Organizes and delivers regular PRS staff meetings.
Serves in a leadership role/role model, providing support and guidance to co-workers during scheduled work hours;
Prepares written evaluations staff annually. Reviews and approves evaluations for all other PRS staff on an annual basis.
Assists in preparing/running client reports, ensuring quality and exceptional customer service;
Performs other duties as requested by the Sr. Manager, PRS.
Supports a positive working environment;
Identifies and resolves potential personnel/peer problems and issues proactively, readily utilizing Sr. Manager, PRS as required.
Communicates to Sr. Manager, PRS all problems, issues and/or concerns as they arise;
Communicates to the Sr. Manager, PRS and/or QI manager any issues or concerns related to quality of care, using HealthCare procedure;
||10008 North Dale Mabry |
Tampa, FL 33618
THIS JOB HAS EXPIRED