Health Management Systems, Inc. Supervisor, Clinical DRG Validation in FL, Florida
HMS makes the healthcare system work better for everyone. We fight fraud, waste, and abuse so people have access to healthcare—now and in the future. Using innovative technology and powerful data analytics, we help government and commercial payers reduce costs, increase quality, and achieve regulatory compliance. We also help consumers take a more active role in their own health. Each year, we save our clients billions of dollars while helping people live healthier lives. At HMS, you will develop new skills and build your career in a dynamic industry while making a difference in the lives of others.
We are seeking a talented individual for a Supervisor, Nurse Review who is responsible for supervising the day-to-day activities of Nurse Reviewers and assignments for HMS contracts. Ensures productivity and quality metrics are achieved.
Responsible for the following components of staff administration: recruiting, performance management, and oversight of non-exempt staff.
Responsible for ensuring adherence to departmental budget by managing resources and over time while staying in budget.
Provides training, coaching, and mentoring to staff as appropriate.
Acts as an escalation point for teams, supporting all customers to ensure a high level of customer satisfaction.
Monitors review workloads from all contracts and assigns and distributes cases to nurse reviewers.
Performs secondary abstractions for quality assurance activities for various contracts and works with management to tabulate and report results.
Coordinates reviews with Medical Director and physician reviewers as appropriate.
Serves as a resource to participants in project/contract activities.
Responds to inquiries from providers as appropriate.
- Performs other functions as assigned
Knowledge, Skills and Abilities:
Proficient in Microsoft Word, Excel, and Power Point and generate MS Office Suite reports.
Ability to operate with strong personnel management skills to motivate staff and take corrective actions when necessary.
Ability to perform well in team environment, with staff at all levels, to achieve business goals.
Ability to function under pressure and with deadline oriented project demands as well as manage multiple initiatives.
Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements.
Ability to work proficiently with Microsoft Word, Excel, Power Point and Access.
Ability to work independently to meet predefined production and quality standards
Ability to sit and work at a computer for an extended period of time.
Average manual dexterity in use of a PC, phone, sorting, filing and other office machines.
Working knowledge in and successful application of basic level of health care data analysis and clinical review.
Work Conditions and Physical Demands:
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 3-5% of time based on business needs
- Unrestricted RN license required
- Bachelor’s degree in nursing or related field required
Minimum Related Work Experience:
10 year’s clinical experience with 7 year’s utilization review experience
2 year’s management or supervisory experience preferred
Customer service and/or provider relations experience required
DRG coding and review experience preferred
Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.
Title: Supervisor, Clinical DRG Validation
Requisition ID: 18001100