Utilization Management Supervisor

UPMC Utilization Management Supervisor (Hybrid)

Responsible for the development and ongoing daily activities of the UM staff within the organization. Provides oversight of OASIS documentation accuracy to ensure positive clinical and reimbursement outcomes

Monday-Friday 8:00 am-4:30 pm. This position is mostly remote. Candidate will need to live near UPMC facility for training and meeting new hires on site.

Responsibilities:
 

• Directs and provides education to all UM Professionals regarding the assessment of patients and the establishment of a plan of treatment at the start of care and reimbursement issues including complex reimbursement system and individual payor home care eligibility requirements. Serves as the OASIS resource/educator and oversees OASIS compliance and competencies. Educates, reviews and supervises ICD-10 code assignments, completion of 485?s/POC, OASIS assessment completion and corrections, and complies with end of month deadlines.
• Focuses on customer service and continually strives to perform the duties of their job in a manner that will result in optimal patient satisfaction. Support staff to obtain and maintain ICD coding and OASIS certifications. Conduct a comprehensive review and analysis of the patient's Plan of Treatment using standard tools and guidelines. Proven ability to facilitate change.
• Responsible for the continuous performance monitoring appraisals for staff and is responsible for overseeing ongoing performance issues. Performs interviewing, hiring, payroll and other employee related activities. Compile and analysis productivity of UM professionals to ensure timely review and distribution of workload. Gathers and disseminates information to appropriate personnel in order to enhance OASIS accuracy and the achievement of positive clinical and financial outcomes.
• Participates as a member of agency committees. Attends compliance training and adhere to the organization's standards of conduct, policies and procedures. Performs in accordance with system-wide competencies/behaviors. Performs other duties as assigned.
• Assists in the development, coordination and facilitation of the orientation plan for all employees and yearly education and mandatory competencies. Performs duties and job responsibilities in a fashion which coincides with the service management philosophy of the organization towards patients, visitors, staff, peers, physicians and other departments within the organization. Identifies, develops and participates in process improvement opportunities within the home health organization that will enhance the quality of services we provide.