Utilization Review Jobs in Reno, NV (NOW HIRING)

Position Purpose
This position is responsible for managing the operational, financial, quality, patient experience and regulatory compliance of assigned practice(s). This position directs and oversees the management of operations with respect to their assigned practice(s). This position has the responsibility to ensure the site is meeting and exceeding established metrics and financial goals set by Renown Medical Group and is responsible to utilize current reporting tools to monitor daily performance and develop action plans as needed to meet established standards. In addition, this position will utilize dashboards and reporting tools in collaboration with lead physicians to manage practice operations and staff. This position will utilize principles of the daily management system to track and meet practice metrics, organizational goals and ensure successful management of the assigned practice(s).
Nature and Scope
The Practice Site Leader works collaboratively with Lead Physicians, Providers, Registered Nurses, and staff, Renown Medical Group leadership, and Renown Medical Group support services to ensure the successful operation of high quality, efficient office practices. The Practice Site Leader works in collaboration with the clinical leadership of the site to ensure successful management of an assigned practice(s) as defined by the established metrics. This position ensures the implementation and adoption of best operational practice, monitors clinical compliance such as OSHA and CLIA, and is responsible for analyzing financial data and budgets in order to make informed recommendations for continuous improvement. The Practice Site Leader must be able to successfully communicate across a wide spectrum of audiences, lead change initiatives, have strong financial and organizational skills and be able to function effectively with multiple priorities. This position is challenged to oversee and maintain operations at assigned practice(s). This includes utilization of tools and dashboards to review and prepare reports related to the performance of the practice as well as assessing and implementing short and long-range action plans and goals to ensure efficient functioning, quality care, and patient / physician satisfaction and engagement.
The responsibilities include but are not limited to the following areas:
Accountability and thinks strategically:
1. Champions innovation and supports change
2. Promotes continuous learning and employee development
3. Problem solving and addressing issues raised by physicians, employees and patients
4. Provide leadership and development of the team
5. Utilize reporting tools to track performance of the practice and develop associated action plans
6. Develops plans for practice in conjunction with Area Practice Managers and/or Administrative Directors and clinical leadership:
7. Develops and manages action plans based on site metrics to meet and exceed established goals.
Utilizes Daily Management System Tools to Identify Needs and Define Actions
1. Works collaboratively with clinical leaders to escalate critical metrics through a tiered huddle daily
2. Utilizes dashboards and reports to evaluate performance and develop action plans as needed
Provides excellent service to all customers:
1. Exemplifies excellent customer service towards patients, families, visitors, volunteers, physicians, staff, and co-workers
2. Demonstrates courtesy, compassion and respect
3. Communicates with all customers (internal and external) in a positive and professional manner
Operational best practices and service excellence standards
1. Implements and maintains best practice operations through evaluation of resource utilization, clinic flow, and Epic System integration
2. Supports providers in achieving scorecard targets related to clinical quality
3. Responsible for achieving patient satisfaction goals assigned for each practice(s)
4. Responsible for achieving employee engagement goals for each practice(s)
5. Responsible for hiring and evaluating practice staff with input from practice physicians and registered nurses.
6. Ensures compliance with all regulatory guidelines and agencies
7. Continually evaluates operations, analyzes processes and initiates changes
8. Supports the ongoing provider utilization of Epic
Financial Management
1. Develops budget plans in alignment with Renown Medical Group goals
2. Responsible for efficient, accurate, and prudent financial management of assigned practice(s), adhering to the annual budget
3. Monitors monthly revenues and expenses, in part by maintaining cost-effective personnel and supply utilization
4. Meets regularly with physicians to review physician compensation results, financial performance and discuss operational issues
5. Meets monthly and ensures A/R management in collaboration with Professional Billing Department
6. Proven proficiency in financial management, which includes comprehensive understanding of insurance plans as they relate to physician practice.
Demonstrated ability to facilitate change and build effective teams
This position does not provide patient care.
Disclaimer
The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.
Minimum Qualifications
Requirements - Required and/or Preferred
Name
Description
Education:
Must have working-level knowledge of the English language, including reading, writing, and speaking English. Requires basic mathematical skills. Associate's degree or equivalent experience required. Bachelor's degree in business administration, healthcare administration, nursing or a related field strongly preferred.
Experience:
Three years of increasingly responsible health care experience; and/or one year of clinic management or business management experience.
License(s):
None
Certification(s):
None
Computer / Typing:
Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel, and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.