Contract Utilization Review Jobs in Decatur, GA (NOW HIRING)

The Team Manager is the leader of the Patient Care Team and that member of the team whose function is to: supervise, evaluate and coordinate the various component members of the interdisciplinary team; assure continuity of care from admission to discharge or transfer to bereavement; serve as patient advocate and coordinator for other social service and health care providers in the community who are involved in the care of the team's patients; assume responsibility for the maintenance of patient records from intake through discharge or transfer to bereavement.

Patient Care Services

• Directs all patient care services for the team, including volunteer and bereavement, and ensures that services are rendered as integrated components of the interdisciplinary plan of care.
• Reviews information on all pending patient admissions, all new admissions (assessments and history) and "alive" discharges to assure that eligibility and appropriateness criteria are met.
• Collaborates with both the team physician and the attending physician regarding palliative care measures for pain and symptom management.
• Assures complete and accurate data and documentation are available to make recertification decisions and further assures that those decisions are made on a timely basis.
• Reviews all imminent "alive" discharges to assure effective discharge planning.
• Monitors the type and level of team services provided (staffing, medications, HME, supplies, level of care changes to inpatient and continuous care, etc.) to assure that they are appropriate and responsive to patient/family needs and expectations.
• Manages the team schedule and assures coordination of services 24 hours a day, 7 days a week to all patients on the team.
• Facilitates team meeting, assuring interdisciplinary input into the update and revision of the plan of care in concert with the changing needs and expectations of the patient and family.
• Participates in on-call rotation.

Staff Supervision and Management

• Interviews, selects, trains, supervises, evaluates and dismisses team staff in conjunction with the Patient Care Administrator
• Assures staff competence and performance levels through making field visits, evaluating documentation and providing team based in services on Vitas values, hospice principles and practices and specific team growth needs.
• Acts as a resource and mentor for staff re clinical issues, documentation, inter- and intra- team problem solving and appropriate customer service behavior
• Oversees staff and volunteer schedules, scheduling and territory assignments to assure that workload is distributed equitably and that all staff are able to meet overall productivity expectations.
• Reviews and approves payroll, assuring that employees have documented accurate time, mileage and additional expenses.

Quality Improvement/Regulatory Compliance

• Monitors clinical records and all team activities to ensure that they are accurate, complete and meet required standards in accordance with VITAS policy and all regulatory bodies.
• Develops and implements performance improvement activities to respond to service issues and challenges and participates from time to time in program relating to quality and service improvement.
• Ensures that team completes proactive and other patient/family satisfaction surveys, and implements Quality Improvement measures and standards.
• Assists with surveys and requests from regulatory bodies and intermediaries as directed by local program.
• Performs substantive chart reviews to assure there is evidence that quality care is being delivered.
• Participates in the Outcomes Management and annual program review.
• Performs utilization review of continuous care and inpatient levels of care for all patients on team.

Customer Service/Sales/Marketing

• Assures that problems/grievances/service failures experienced by individual patients/families or physicians/MCOs are addressed with team members, vendors, other VITAS departments, and are resolved promptly and satisfactorily.
• Analyzes customer service issues on team to identify causes and works with individual team members as well as entire team to improve performance.
• Personally speaks with patients/families and their attending physicians when patient is considering revocation to seek satisfactory solutions to avoid unnecessary revocation.
• Regularly visits LTC and Contract Bed facilities to assure care plan integration, customer satisfaction and to discuss criteria for determining appropriateness.
• Participates in providing inservices to customers along with other team members, Patient Care Administrators and other program staff.
• Participates in professional, voluntary or community service organizations

Cost Containment

• Verifies/approves admitting IPOC diagnosis, treatments, staffing and supplies.
• Monitors utilization of resources by every patient to assure cost effective delivery of services.
• Controls and is accountable for productivity, labor and all related patient care costs with respect to budget.
• Approves all bills/invoices related to patient care services

Professional Development

• Attends inservices, educational seminars and workshops.
• Develops and achieves professional growth goals and objectives.
• Participates as a mentor of newly hired Team Managers.

QUALIFICATIONS

• Reliable transportation with appropriate license and insurance coverage for driver and passengers.
• Private telephone in home.
• Knowledge of the principles and practices of primary medical and nursing care, with at least a working knowledge of oncologic nursing and palliative care.
• Basic understanding of the interpersonal dynamics operative within the working relationships of an interdisciplinary health care team, and knowledge of the process of dying and bereavement.
• Working knowledge of VITAS information system (Vx) and the ability to utilize management reports.
• Two years successful supervisory experience or equivalent in a health care organization.

EDUCATION

• Bachelor's degree preferred.
• Current and valid R.N. License to practice in the state where the VITAS program is located.

SPECIAL INSTRUCTIONS TO CANDIDATE

• EOE/AA M/F/D/V

#GAClinical

VITAS Healthcare is the nation's leading provider of end-of-life care, and has the resources and expertise to support your personal and professional growth.  As a member of the VITAS team, you'll find fulfillment working for a people-focused organization dedicated to making a difference in the lives of others. You will be more than just an employee: You will be counted on as an expert in your field, and as a valued team member whose efforts are respected and vital to our hospice mission.

All VITAS employees commit to fulfilling their duties and responsibilities with the highest regard for professionalism, collaboration and teamwork, and an eye focused constantly on growth and improvement. We serve with commitment and compassion, and position ourselves for the future by embracing, innovating, and leading change. If you are that person, make your voice heard-find your purpose at VITAS today.

Benefits Include:

- Competitive compensation 
- Health, dental, vision, life and disability insurance
- Pre-tax healthcare and dependent care flexible spending accounts
- Life insurance
- 401(k) plan with numerous investment options and generous company match
- Cancer and/or critical illness benefit
- Tuition Reimbursement
- Paid Time Off
- Employee Assistance Program
- Legal Insurance
- Roadside Assistance
- Affinity Program

Many of our positions offer the opportunity to work day or night shifts, weekdays or weekends.

Choose a Career with VITAS