Director of Home Health Clinical Operations Job in Nashville 37214, Tennessee US
Director of Home Health Clinical Operations
Position Description:
• Daily oversight and directions of the clinical and DME teams to assure compliance with departmental policies and procedures, compliance with specific payor requirements, and clinically sound decision making
• Daily oversight and direction of the Quality Coordinator and the Quality Program.
• Serves as a liaison for the quality program and leadership.
• Develops and maintains policies and procedures, the utilization program and work plan, and the quality program
• Provides oversight ad directions for adverse event/ quality incident reporting and disciplinary actions that may be required
• Participates in the Operational Performance committee as the chair person, conducting the monthly meetings.
• Participates as the chair person of the Clinical Sub-Committee of the Operational Performance Committee
• Monitors and provides quality improvement leadership for the UM program operational procedures.
• Monitors utilization patterns and cost associated with those patterns, reporting to the Operational Performance Committee, quarterly, and payors as requested
• Provides ongoing education of the staff on case management practices and cost savings opportunities
• Keeps the staff abreast of contractual changes with payors and the provider network
• Assists with claims resolutions and issues with providers and payors
• Maintains a working relationship with all providers in the network, making on-site visits as necessary
• Educates providers on regulatory requirements of the payors and policies and procedures of WHCN
• Represents WHCN at payor meetings, provider contracting meetings, and trade shows
• Assists with contracting of new network providers in conjunction with the CEO
• Directs the problem resolution process for the staff, providers, and payors to bring about customer satisfaction and maintain a high level of quality care
• Assists with overflow referral review and data entry when necessary.
• Supports the resolution of potential personnel/peer problems and issues and /or concerns as they arise.
• Ensures staffing is adequate for a quality of care job through the UM program operational procedures.
• Communicate appropriately to provide leadership to staff according to policy and procedure, regulatory requirements and company requirements.
• Works and communicates and collaborates with all outside regulatory bodies in harmony with compliance and quality.
• Supports a positive working environment.
EDUCATION/EXPERIENCE REQUIRED:
• Nurse with current TN license without restrictions to practice. Bachelor Degree in Nursing (BSN) preferred but will consider candidates based on years of experience.
• Two to three years experience in medical management required. Managed care and DME experience preferred.
• Five years in home health nursing with management experience required.
• Proficient computer skills including Microsoft Word and Excel.
• Strong communication skills.
• Strong written, verbal, and customer service skills required.
• Detail oriented and ability to work independently.
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