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Manager overseeing medical review processes for Medicare claims at BlueCross BlueShield of South Carolina. Ensuring compliance with standards and laws while driving continuous improvement in claim processing.
About the role
- Clinical Manager overseeing hospice services at Affinity Hospice. Responsible for coordination and management of patient care with an interdisciplinary team.
Responsibilities
- Review case referrals and assess patient needs, including conducting home visits
- Assign appropriate hospice associates and collaborate with the Medical Director to determine eligibility for services
- Oversee and evaluate patient cases through home visits, conferences, and record reviews
- Provide guidance to clinicians to improve performance and service delivery
- Review patients' medical diagnoses, prognoses, medications, procedures, and clinical courses
- Assist clinicians in establishing therapeutic goals, setting priorities, and developing effective care plans
- Lead case conferences with hospice associates to ensure care coordination and interdisciplinary collaboration
- Conduct quarterly record reviews and provide findings and recommendations to the Executive Director and clinical staff
- Participate in the hiring, screening, and orientation process for new associates, providing training and mentorship
- Assist in planning, implementing, and evaluating in-service and continuing education programs for staff
- Support policy and procedure development
- Ensure compliance with professional standards and principles
- Assess community health needs and contribute to program development to meet those needs
- Engage in public relations and community activities to promote the organization’s role in hospice care
- Actively participate in quality assessment and performance improvement initiatives
- Perform other duties as delegated by the Executive Director
- Familiarity with fundamental accounting practices, general ledger management, and financial reporting standards
- Strong ability to accurately process data, identify discrepancies
Requirements
- Registered Nurse with current licensure to practice professional nursing in the state
- Graduate of a National League for Nursing (NLN) accredited school of nursing; BSN preferred
- Minimum of two (2) years of management or supervisory experience in a hospice or home care setting
- Proven ability to work effectively within an interdisciplinary team
- Active and unencumbered Registered Nurse (RN) license in the state of employment
- Valid driver’s license with an insured and operational automobile in accordance with state and/or organization requirements
- Current CPR certification
Benefits
- Paid Time Off (PTO)
- Sick Time
- Holiday Pay
- Benefit Package (Medical, Dental, Vision and more) for full-time employees
- 401K
- Employee Assistance Program
- Tuition Reimbursement for eligible employees
- Internal Company Advancement
- Free end of life training
Job title
Job type
Experience level
Salary
Not specified
Degree requirement
Location requirements
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