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CLINICAL SUPERVISOR - AULTCOMP Job in Canton, Ohio US
CLINICAL SUPERVISOR - AULTCOMP
Aultcare Corp.
-
Canton, OH
Posted:
4/7/2024
- Expires:
7/6/2024
Job ID: 272077973
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Job Description
Req# 28535
Aultman Health Foundation, CANTON, OH
AULTCOMP MCO INC
Aultman Health Foundation
Full Time, Day Shift, varies
PURPOSE OF POSITION:
The primary purpose of the Quality & Medical Management Supervisor is responsible to coordinate and supervise the day to day functions of the medical management department in an efficient, cost-effective manner in accordance with governing and accrediting bodies' policies and standards. The Quality & Medical Management Supervisor offers guidance to the staff to assure all applicable laws, rules, guidelines, policies, URAC standards and contractual requirements are adhered to. The Quality & Medical Management Supervisor will accomplish this goal by devoting on average thirty to forty percent of their time on quality outcomes. Continually leading by example to provide and facilitate efficient, quality service at all times.
RESPONSIBILITIES & EXPECTATIONS:
Establish, maintain and enforce policies and procedures to conform to all governing and accrediting bodies to include but not limited to: URAC, Ohio Bureau of Workers' Compensation (BWC), and the Industrial Commission(IC). Coordinate the URAC Accreditation process:
Primary contact
Manage all incoming and outgoing communications.
Assure attestation and any organizational changes are completed timely.
Build the URAC application and its submission to the URAC Accreditnet portal.
Coordinate the on-site audit and assure all documentation is available and flagged for their review.
Collect, analyze and report performance measures as required by URAC.
Coordinates quality improvement data collection/evaluation process:
Collects/evaluates data for medical management, vocational rehabilitation, billing, first report of injury and other processes, as needed.
Reports findings to the management staff at AultComp MCO and the Quality Taskforce.
Develops quality work and action plans.
Writes and maintains QI projects as determined by the QI Taskforce.
Coordinates and/or oversees audits:
BWC Audits and/or responses to CAR
Internal Audits
Assists Manager and Systems & Finance Analyst with SSAE16 Audit
Coordination of policymaking regarding AultComp MCO's/BWC's guidelines and policies. Evaluates and coordinates AultComp MCO policy changes to remain compliant with URAC standards.
Provides educational support for staff, injured worker, medical provider, and employer regarding the workers' compensation process, URAC, BWC/AultComp MCO guidelines.
Documents clear concise notes in the system following activity on cases.
Process Improvement: Continuously reviews, recommends and implements improvement steps, as needed or directed.
Seeks supervisory guidance/approval as appropriate.
Portrays professional image: follows dress code; communicates with internal and external customers in a professional manner, including appropriate verbal and written grammar.
Promotes and demonstrates professional standards to enhance the development of the department including:
Performs all job functions in an independent manner (as needed or directed)
Recognizes and performs job functions with little or no supervision
Demonstrates strong organizational skills
Responds positively to change in work flow as needed
Offers assistance to co-workers (as needed)
Maintains flexibility to meet department needs, including adjusting work hours
Consistently completes assigned work in required time frame; completes other duties as required
Collaborates and cooperates with co-workers, supervisors, etc., creating a productive working relationship throughout the organization
Actively seeks and pursues opportunities to make a contribution and demonstrates desire for learning
Practices Ethical Conduct:
Demonstrates honesty and integrity in all functions and relationships
Maintains AultCare standards of confidentiality, including HIPAA privacy guidelines
Complies with policies and procedures at all times
Meets acceptable attendance and punctuality expectations (excluding FMLA)
The above statements reflect the general duties considered necessary to describe the principle functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent to this position.
AultCare/AHF will provide reasonable accommodations to employees or applicants with disabilities, as defined by the Americans with Disabilities Act, who are otherwise qualified to safely perform the essential functions of the job, with or without accommodation, unless such accommodation would constitute an undue hardship on AultCare/AHF or poses a direct threat to the health and safety of the individual or others that cannot be sufficiently mitigated by reasonable accommodation. Any applicant or employee who requires an accommodation to perform the essential functions of his or her job or to enjoy equal benefits and privileges of employment should notify the AultCare Human Resource Department and request such accommodation.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, disability, gender identity, sexual orientation, or protected veteran status. AultCare is an EEO/AA Employer M/F/Disability/Vet.
QUALIFICATIONS:
Education:
Licensure or certification in a health related field that allows the professional to conduct an independent assessment as permitted with the scope and practice of the discipline.
Two or more years of experience in direct clinical care. Preferably in orthopedics and/or occupational clinic setting.
Ohio Bureau of Workers Compensation medical case management a plus.
One or more of the following:
Certification as a case manager as described in the policy "Recognition of Case Management Certification
A bachelors (or higher) degree in a health related field
Current, valid, unrestricted registered nurse license (RN) in the State of Ohio
At least three years' experience as a case manager
After three or more years of directly managing and supervising case managers, the AultComp MCO Medical Management Supervisor shall have obtained and hold a certification as a case manager.
Maintains professional licensure/certification.
Remains current in educational areas related to job description.
Organized self-starter with focus on goals and deadlines.
Previous experience utilizing spreadsheet, database or related software preferred.
Requires excellent interpersonal skills and evaluation skills.
WORKING CONDITIONS:
Hours of operation, shifts as assigned. Occasional overtime, on-call, off-shifts (evenings and/or weekends) scheduled as necessary.
Lunch and break periods must be coordinated with other staff members to maintain adequate office staffing during departmental operating hours.
Sitting/standing/moving about intermittently during working hours.
Subject to frequent interruptions and changes in priority of duties throughout the day.
AultCare is an Equal Opportunity Employer (EOE) that values and respects the importance of a diverse and inclusive workforce. It is the policy of the company to recruit, hire, train and promote persons in all job titles without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, protected veteran status or disability. We recognize that diversity and inclusion is a driving force in the success of our company. AultCare is an Equal Opportunity Employer that will make reasonable accommodation to enable individuals with disabilities to apply and compete for employment opportunities for which they are qualified. To request an accommodation, please email our Human Resources department at
kbricker@aultcare.com
, or call 330-363-6388, for further assistance.
See all jobs from this company
Job Summary
Employment Type:
Full Time Employee
Job type:
Federal Contractor
Skill Based Partner:
No
Education Level:
Bachelor's degree
Work Days:
Mon, Tue, Wed, Thu, Fri
Job Reference Code
78917531
Salary
N/A
Licenses / Certifications:
N/A
Display Recommended WorkKeys®
Recommended WorkKeys®:
Applied Math: 5
Graphic Literacy: 5
Workplace Documentation: 5