UM Inpatient Clinical Supervisor RN at Impresiv Health

• Supervise the appropriate UM Nurse RN and Social Worker staff to remain in compliance with UM guidelines and Policy and Procedures; Responsibility • Works closely with the UM Clinical Trainer to develop training material and train UM staff as appropriate regarding use of the all platforms and the core adjudication system as it relates to the UM process; • Provide oversight for specialty and ancillary service referrals using established criteria for purposes of pre-authorization of payment. • Reviews decisions regarding hospital admissions and length of stay, and outpatient procedures for all care delivered to the membership as related to coordination of services upon discharge; • Assists with coordinating discharge planning activities with facility discharge planners to facilitate members transitions of care; • Benefits interpretation to include coordination of care for medically necessary services that are not covered under the Plan e.g. CCS, Mental Health, Long Term Care, State Waiver Programs. • Works closely with the Case Management to facilitate needs for members identified as High Risk or requiring coordination of services; • Assist the UM clinical staff in the review of claims for the accuracy and appropriateness of billed charges; • In coordination with the UM Auditor/Analyst staff, perform periodic audits of the UM Nurse RN and Social Workers of inpatient clinical decisions for appropriateness and accuracy of documentation and summarize and report the results of the audit; • Manage timecards, PTO, flex, and vacation schedules; • Assist Director of Utilization Management in the development and updating of UM criteria, guidelines, and policies; • Provide guidance to clinical staff regarding Behavioral Health and other mental health conditions regarding coverage and coordination of services with community partners; • Ensure coordination of medically necessary services within the plan and with community;

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UM Inpatient Clinical Supervisor RN

Requirements and responsibilities

Skills wanted:

Language(s) required:

Marcus Fontaine

About Impresiv Health:

www.impresivhealth.com/

Admin access needed

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