Job Information
Catholic Health Middle Revenue Cycle Clinical Supervisor in Buffalo, New York
Facility: Administrative Regional Training Cntr
Shift: Shift 1
Status: Full Time FTE: 1.000000
Bargaining Unit: ACE Associates
Exempt from Overtime: Exempt: Yes
Pay Range : $83,343-$125,034
Work Schedule: Days
Hours:
M-F 7-3 or 8-4 with some evening and weekends coverage as needed
Summary:
The Middle Revenue Cycle – Clinical Supervisor, as an active member of the Middle Revenue Cycle and interdisciplinary care team and works in conjunction with the Utilization Review Manager and Manager Clinical Documentation Integrity. The Middle Revenue Cycle – Clinical Supervisor is responsible for training and mentoring Utilization Review, Clinical Documentation Integrity and Clinical Denials and Appeals teams. They ensure the teams receive comprehensive education on policies, procedures, regulations, denials, and clinical criteria. The role provides guidance, support, and feedback to facilitate skill development and successful job performance. The supervisor also serves as a secondary review/escalation point for potential or unanswered provider queries. Is responsible for identifying areas of focus and necessary process refinement through report analysis. Leads Middle Revenue Cycle team in enacting process changes and measuring efficacy and impact of results. Serves as a resource for physicians and administration regarding issues related to the appropriateness of inpatient DRG assignment and Level of Care. Coordinates follow-up audits to ensure full compliance with regulatory requirements.
This individual also works to maintain third-party payer relationships related to Utilization Review Activities. This includes, but is not limited to, concurrent review, responding to inquiries, complaints, and other correspondence, and may include setting up discussions between parties. Knowledge of state and federal laws relating to contracts and utilization of review processes is vital.
Responsibilities:
EDUCATION
Bachelor of Science Nursing (BSN) degree
Registered Nurse with a current New York State license
CERTIFICATION
Holds, or will obtain within one year of hire, Certified Clinical Documentation Specialist (CCDS)
Holds, or will obtain within two years of hire, Certified Case Manager (CCM), Preferred
Certification in a Nationally Recognized Utilization Review Criteria set is preferred
At least 1 years’ experience in working with third party payers strongly preferred
Must maintain New York State RN license
EXPERIENCE
Minimum of eight (8) years of experience working in an Acute Care Hospital Setting
Minimum five (5) years of experience working within Utilization Review/Case Management/Clinical Documentation Integrity or
Minimum of two (2) years of experience managing professional clinical staff in the role of documentation review against a criteria set including but not limited to utilization review, Clinical Documentation Integrity, quality improvement or chart audit/review or
Minimum two (2) years of experience managing a professional clinical team with one of the major consultant firms or
Minimum of ten (10) years of nursing experience that includes clinical documentation and/or utilization review experience
Proficiency in utilization management/clinical documentation Integrity and regulatory requirements required
Experience in working with people who are geographically dispersed
Proven success in implementing system-wide UM/CDI standardization
Proven ability to mentor and coach others effectively
KNOWELDGE, SKILL AND ABILITY
Ability to lead, challenge, motivate, coordinate and facilitate teams across the utilization management continuum
Understanding of clinical quality and utilization metrics used to design value-based contracts and measure performance in health care
Excellent interpersonal communication and networking skills to develop positive, productive and collegial working relationships with multiple internal /external stakeholders across the continuum
Excellent critical thinking skills, Actively and skillfully conceptualizing, applying, analyzing, synthesizing or evaluating information gathered from or generated by, observation, experience, reflection, reasoning or communication as a guide to action
Excellent knowledge of Microsoft office, word, excel and power point; Webex/Teams programs
Knowledge of Quality Improvement, Root Cause Analysis, CMS and Joint Commission regulations
Fosters trust and exchange of ideas across departments to innovate and hardwire highly reliable practices
Ability and skill to create a learning environment and foster growth
Ability to manage in complex and demanding contractual relationships
Analytic skills for detailed reporting, creating dashboards and interpretation
Effective decision maker – able to gather facts, assess all perspectives and weigh different possibilities to influence positive outcomes
Adaptability – maintain effectiveness when experiencing major changes in work tasks or the work environment, able to adapt to change in environment and/or circumstances with a positive outlook and adjusting effectively to work within the new processes
Proactively prioritizes initiatives, effectively manages resources and keen ability to multi-task
Initiative – independently takes prompt proactive steps towards problem resolution
Facilitation – ability to facilitate small and large groups of people at various organizational levels for purposes of planning, problem solving, strategic development and policy changes
Demonstrated understanding of complications, co-morbidities, severity of illness, risk of mortality
Knowledge of ICD-10, current knowledge of coding clinics including recent changes/updates, and understanding of the various DRG methodologies (AP-DRG and MS-DRG)
Extensive clinical knowledge and understanding of pathology/physiology; best demonstrated by clinical experience in hospital setting.
Self-Confident personality traits to facilitate ongoing physician communication
Ability to relate well and establish partnerships with the providers to maximize the quality of documentation for Catholic Health patients
Ability to work independently in a time-oriented environment
ENVIRONMENT
- Normal heat, light space, and safe working environment; typical of most office jobs