Manager of SNF anad Clinical Documenation

POSITION SUMMARY:

 

The Health Services Manager of SNF Management and Clinical Documentation is responsible for management of the SNF business unit and for ensuring departmental compliance with Federal (CMS) and State Regulatory Requirements. Provides direction and oversight to ensure that SNF utilization management activities are carried out in a manner which is efficient and best meets the needs of Bravo Health members. The Manager of SNF Management and Clinical Documentation performs compliance audits and trainings, and creates policies and materials as needed to support Health Services’ compliance initiatives.

 

ESSENTIAL DUTIES AND RESPONSIBILITIES:

 

SNF·        Management of day-to-day SNF activities carried out by SNF business unit staff members.·        Directs telephone access, oversees skilled nursing process, and coordinates day-to-day activities of the department.·        Develops and implements quality improvement initiatives related to SNF care and discharge activities.·        Responsible for ensuring that policies and procedures are developed and implemented to ensure proper management of SNF days.·        Oversee employees to ensure that SNF admissions are reviewed in a timely manner and that on-going reviews take place as appropriate.·        Work with SNF facilities to ensure their compliance with procedures and to promptly address any issues or concerns.·        Performs inter-rater reliability on SNF care decisions.

 

 

Compliance·        Responsible for oversight and daily management of all Health Services regulatory requirements and denial letters that require compliance review.

·        Manages the Clinical Documentation department on a daily basis and works with  other Health Services management to ensure smooth and seamless functioning in the Health Services Department overall.·        Performs inter-rater reliability on all required clinical documentation letters.

·        Ensures compliance with NCQA Standards and CMS Guidelines. Works with regulators and the Health Services Management Team to resolve compliance issues.·        Acts as a liaison between the Health Services and the Corporate Compliance department to facilitate meeting clinical documentation requirements.

·        Participates in policy development, audit preparation, mock audits and on-site regulatory audit reviews.

·        Maintains the Health Services regulatory database to ensure accuracy and currency of all materials.

 Minimum qualificationS:

 Bachelor of Science in Nursing or a Bachelors degree in a related field.  Five (5) years experience in managing people preferred.Documented track record of team work and motivation of staff toward common goals.

 

 

KNOWLEDGE, SKILLS AND ABILITIES:

 A minimum of three (3) years of demonstrated SNF experience.Supervisory/management experience.Experience working in a Managed Care/HMO environment.Experience working in an acute care environment.Peri-discharge planning experience.

·        Excellent verbal and written communication skills.

·        Proficient in the use of Microsoft Office Suite.Understanding and experience with Medicare/Medicaid preferred.Understanding of NCQA Guidelines and Standards preferred.

·        Excellent verbal and written communication skills.

·        Skill in identifying and assessing areas of compliance risk. 

·        Ability to motivate and work with staff toward required outcomes.

·        Proficient in the use of Microsoft Office Suite.