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Providence Discharge Planner Supervisor (UM) in Mission Hills, California

Description:

Providence is calling a Discharge Planner Supervisor (UM) (Full-Time/Day Shift) to Providence Facey Medical Foundation in Mission Hills, CA.

We are seeking a Discharge Planner Supervisor (UM) who will be responsible for developing, coordinating and monitoring daily workflow and coverage for all Discharge Planners. Ensures all goals, timeframes and objectives are met. Demonstrates competency and knowledge of HMO/POS/EPO/PPO insurance, eligibility and benefit coverage's/criteria, MSO UM Referral System, EPIC and all network hospitals portal. Must have experience with skilled nursing, home health, hospice, DME, injectables, Medicare parts A, B, C, and D. Demonstrates knowledge of all areas of utilization management, with the ability to handle multiple tasks simultaneously. Serves as a liaison between patients, hospitals, health plans, providers and the organization. Must demonstrate job proficiency as Request Specialist and UM Discharge Planner. Responsible for interviewing, hiring and training new UM Discharge Planners.

In this position you will:

  • Supervise UM Discharge Planners in obtaining daily hospital census information, verification of eligibility, benefits (including co-payment) for in-patient and out-patient procedures, consultations, hospice, home health, durable medical equipment, injectables, ancillary services and home visits.

  • Supervise and holds UM Discharge Planners accountable for coordination of patient aftercare needs, making timely and accurate appointment for patients post discharge and that patient follow up calls are meeting compliance guidelines.

  • Supervise UM Discharge Planners to ensure that all referrals (including pended and denials) are handled appropriately and timely as per Providence MSO Compliance and health plans guidelines.

  • Provide assistance as needed to Discharge Planner Manager, UM Hospital RN Case Management Supervisor, UM Manager, CCM Supervisor, UM Compliance Supervisor and Request Specialist Supervisors.

  • Work collaboratively with Operations Managers, Supervisors and Hospital staff to ensure UM department has exceeded the expectations/needs of all Facey providers.

  • Perform job functions timely and efficiently.

  • Deliver upon the service expectations of both our patients and fellow staff members by listening to their needs; engaging in positive interactions; and following through on promises made in a thoughtful, efficient, timely and courteous manner so that their total outcome is better than expected.

  • Respect the dignity, confidentiality and privacy of patients.

  • Work in a safe manner, adhering to general safety precautions and standards. Reports any unsafe conditions to their supervisor and/or the safety hotline.

  • May assist with health plan audits as requested by UM Compliance and CCM Supervisors.

  • Must understand key compliance metrics in UM Case Management Department and drivers for each metric.

  • Provide assistance to sites for UM Discharge Planner job function.

  • Address patient care and personnel issues in a timely and professional manner. Follows health plan guidelines for timeliness with respect to referrals.

  • Must be able to verify accurate and appropriate health plan contracts, criteria/guidelines and DOFR information as needed for medical review.

  • Track and report monthly productivity statistics which includes post DC follow up appointments, post DC calls, admissions and discharges to the UM Discharge Planner Manager.

  • May assist CCM Supervisor with audits to ensure all requirements for CCM and SNP members are met while patient is hospitalized and reports feedback and makes recommendations to UM Director of Case Management.

  • Give timely and constructive feedback on performance monthly at a minimum; documents all corrective counseling.

  • Problem solves with Site Managers and Hospital Case Management Team to meet our patient customer needs with regard to UM.

  • Maintain appropriate staffing levels to ensure adequate UM Discharge Planner coverage 7 days a week.

  • Back up for UM Discharge Planner when staffing levels are inadequate to meet facility needs.

  • Demonstrate effective supervisory skills:

  • Motivate and manages staff to ensure that performance standards are met or exceeded.

  • Coordinate the orientation process. Ensures that new employees are oriented to their department.

  • Monitor initial/ongoing training and the proper use of UM Referral Tools and job aids. Assists other UM Supervisors and Managers to create effective training tools and tools to manage our work flow for maximum productivity and accuracy of referral and discharge planning process.

  • Collaborate with UM Compliance Supervisor to ensure that new Discharge Planners receive the training necessary to succeed in their positions and to ensure that current UM Discharge Planners receive ongoing training necessary to keep them informed with new information and new processes.

  • Organize the department workload to promote efficiency and productivity. Monitors individual and group productivity and reports to UM Discharge Planner Manager monthly or as needed.

  • Assist UM Discharge Planner Manager with staff meetings on a monthly basis or more frequently if needed and maintains minutes of all meetings.

  • Assist staff with evaluation and responses to patient complaints. Assists staff in the development and reporting of relevant quality management indicators.

  • Ensure that adequate in-service education is available to staff members.

  • Keep staff apprised of changes in organization and departmental policies.

  • Actively participates in meetings in and out of UM.

  • Demonstrate the ability to make decisions, take appropriate action and follow tasks through to completion.

  • Recognize and analyze the implications of new situations and develops workable solutions to maintain productivity and morale.

  • Act as a role model in demonstrating the customer service standards of the organization.

  • Demonstrate a commitment to personal growth and development by participating in external activities related to professional goals.

  • Prepare and conduct fair and objective performance appraisals in compliance with the organization's performance management program, procedures, standards and guidelines.

  • Respond cooperatively to managers and staff members in other departments to promote teamwork.

  • Attend administrative meetings as appropriate and contributes ideas for improving efficiency, productivity and patient satisfaction.

  • The customer service standards of the organization are reflected in daily work habits:

  • Complaint are researched and responded to the same day if possible.

  • Request from other departments are responded to in a timely and positive manner.

  • Take the initiative to offer to help co-workers in overload situations.

  • Physicians, plan representatives, members and co-workers are treated courteously.

  • Demonstrate behaviors which are consistent with the Code of Conduct and aligned with the Organizations’ mission, vision and shared values:

  • Report promptly any suspected or potential violations to laws, regulations, procedures, policies and practices, and cooperates in investigations.

  • Conduct all transactions in compliance with all company policies, procedures, standards and practices.

  • Demonstrate knowledge of all applicable compliance and legal requirements of the job based on the scope of practice of the position.

Qualifications:

Required qualifications for this position include:

  • UM Referral System, EPIC and ability to navigate in various EHRs of Hospital /Medical Groups. Understanding of the issues and potential gaps in transition of care for post-acute patients.

  • Knowledge of MSO Experienced telephone skills with ability to communicate clearly and distinctly and confirm that effective communication has taken place with caller.

  • Good understanding of HMO/POS/EPO/PPO insurance, medical terminology, ICD/CPT coding and HCPCS medical coding.

  • Knowledge of IDX GE Centricity and ability to navigate in various EHRs of Hospital /Medical Groups required.

  • Understanding of the issues and potential gaps in transition of care for post acute patients required. Good understanding of HMO/POS/EPO/PPO insurance, medical terminology, ICD/CPT coding and HCPCS medical coding.

  • Ability to type 45 wpm, 10-key calculator by touch, strong computer skills with knowledge of MS Outlook, Word, Excel and data entry skills are required.

  • Must be a self-starter, able to initiate ideas and troubleshoot problem areas.

  • Able to work independently and as a team player.

  • Comfortable in a hospital environment interacting with clinical professionals, patients and ancillary providers.

Preferred qualifications for this position include:

  • College education.

  • Two (2) years experience in a clinic, hospital or related health care environment.

  • One (1) year supervisory experience in health care.

  • Experience in utilization related skills in the managed care field.

About the organization you will serve:

Facey Medical Group is a multi-specialty medical group with over 160 physicians providing care to the growing population in the North & East regions of Los Angeles & Ventura Counties. Twelve medical clinics, including two urgent care centers and dedicated women's centers, are located across the San Fernando, Santa Clarita, San Gabriel and Simi Valleys. The group began as a single medical practice over 90 years ago.

Facey is part of Providence Health & Services, an integrated, not-for-profit 5-state network of hospitals, care centers, medical clinics, affiliated services and educational facilities spanning from California to Alaska.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

https://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Clinical Lead Supervisor/Manager

Location: California-Mission Hills

Req ID: 296537

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