Supervisor, Case Management

2 months ago

Westerville, United States Orthopedic One Full time
Position Summary:

Oversees staff responsible for obtaining information or pre-certifications required, ensuring the practice can be reimbursed for professional fees or facility fees associated with patient care. Works in conjunction with Patient Accounts leadership.

Responsibilities/Accountabilities:

Department:
  1. Provides reporting and analysis on performance metrics to ensure appropriate case management procedures are being followed.
    1. Oversee Case Management prior authorization processes to ensure payer medical policy guidelines are met to ensure claims are reimbursed.
    2. Works collaboratively with Manager to ensure communication with outpatient surgery centers and hospitals is clear, complete and timely.
  2. Assigns work to staff and establishes schedules to ensure sufficient operational coverage is in place.
    1. Maintain reporting to ensure team members complete to-dos within established timelines based on criticality.
  3. Coordinate with Accounts Receivable team and clinical staff to ensure retro authorizations are obtained by the case management team members
    1. Determine if pre-authorization was properly obtained.
    2. Track trends on missed opportunities that lead to denied authorizations.
  4. Develop and present educational materials to train new staff members.
  5. Maintain necessary operational skills and knowledge to perform staff responsibilities.
Staff Selection and Performance Management:
  1. Works with HR to interview and select staff and timely completion of related documentation.
  2. With HR Support, ensures performance appraisals define and measure a high level of work performance.
  3. Completes introductory and annual performance appraisals based on observed behaviors and work outcomes supported by appropriate documentation.
  4. Works to understand how staff are motivated and balance the needs of the organization and the individual. Sets expectations and rewards staff or achieving desired performance.
  5. Initiates coaching, disciplinary action, and performance improvement planning to address violations of policy and/or poor performance.
  6. Facilitates conflict resolution with staff with support as required based on circumstances.
Orient and Train Staff:
  1. Orients new staff, ensuring they know the purpose of the organization, their department and position.
  2. Ensures that employees have resources, tools, feedback, assistance and training needed to achieve desired performance including productivity and qualitative expectations.
  3. Provides effective and timely on-the-job training such that performance objectives are clear, staff members have knowledge and skills necessary to perform effectively.
  4. Builds learning into work performed such that staff gains increasing understanding of how and why work is performed.
  5. Instruction and information provided to staff results in complete understanding.
  6. Educates staff on all applicable new or established policies, procedures, and expectations.
Leadership:
  1. Supports the mission, vision, values and code of conduct, goals and objectives of Orthopedic One.
  2. Proactively reviews metrics important to the department workflow including work volume, customer satisfaction measures, etc. and makes recommendations to modify schedules, staff hours/staffing levels, and workflows to maintain productivity, quality, and accuracy.
  3. Decisions, including those pertaining to staff, reflect complete and accurate analysis of relevant issues (past practices, work history, individual and group performance, department and company needs, consistency, fairness, regulatory or legal concerns, etc.).
  4. Adheres to and administers company policies consistently and fairly in all matters (Employee Handbook, P&P, Risk, etc.).
  5. Manages time and attendance to ensure employees are paid accurately and consistently based on company practices and policies.
  6. Maintains department schedule/calendar and provides timely response to PTO requests.
  7. Submits reports/documents to appropriate parties in a complete, accurate and timely fashion (Personnel Action Notice, expense reports, etc.).
  8. Promotes and supports an environment in which staff members engage in appropriate professional development, continuing education and lifelong learning opportunities.
Professional Development:
  1. Prepares appropriately to attend and participate in company meetings or projects as assigned.
  2. Facilitates special projects or assignments at the request of management.
  3. Attends to own professional development responsibilities and encourages/plans for staff to do the same.
Teamwork:
  1. Works cooperatively with coworkers, providers, and management.
  2. Shares knowledge and insights with co-workers in a constructive manner.
  3. Willingly provides coverage to department, staying beyond scheduled ending time when clinic schedule demands it, volunteering to cover time off or unexpected absences, maintaining workflow in department without direct supervision.
  4. Addresses conflicts with person directly before involving manager or uninvolved peers.
  5. Is considerate of others with regard to taking breaks or meal periods, use of computer and telephone, and noise in department.


Education, Experience, and Certification/Licensure Required:
Position requires an Associate's degree in business administration or related field or commensurate work experience. The applicant must have a minimum of five years of experience working in the business office of a healthcare setting, along with supervisory experience. Previous experience with Microsoft Office Suite, and EMR/Practice Management Experience.

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