Compliance and Utilization Review Supervisor

Job Overview

We are seeking a skilled Utilization Review Nurse to join our team. Seeking healthcare professional to provide Clinical Records management to include accurate collection and recording of resident health information, securely storing of resident data, provides regulated access to resident records, adheres to mandated retention periods, and executes secure disposal Aids in critical decision-making processes, safeguards resident privacy, ensures regulatory compliance is met, and improves resident care outcomes.

• Reviews residential treatment staff’ documentation for compliance with COA, CMS and state contract regulations of residential treatment program where youth are enrolled.
• Reviews resident records for accuracy in documentation and completion of treatment resulting in high-quality care administered as economically as possible and in accordance with current COA, CMS and state contract regulations according to evidence-based care guidelines.
• When compliance with mandated documentation requirements issue arises, investigates the matter to identify the root cause and recommend corrective action. Develops corrective action plans: work with leadership to develop and implement disciplinary action plans.
• Reviews surveillance videos and matches activities on screen with written documentation. Compares and reviews random sampling of daily activity records, Q15 forms for accuracy against Incidents of concerns, critical incidents, and restraint records surveillance video.
• Ensures direct care staff adhere to established shift guidelines for resident care. Provides 30 minute relief breaks for DCW during midnight shift.
• Compares services provided to treatment plans developed on behalf of resident and family.
• Acts as an administrator for staff training curriculum and management of agency electronic healthcare records.
• Compiles treatment information requested from outside agencies.
• Prepares discharge package for referring agency and primary caregivers.

Work day hours: 7pm-7am (3-day workweek) or 9pm-7am (4 day work week) $40.00 hourly, FTE with benefits, state health plan, 20 paid days off

Qualifications: licensure required as a RN, LPC, LISW-CP, or LMFT

Job Type: Full-time

Pay: From $40.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Experience:

• Compliance management: 1 year (Preferred)

Ability to Commute:

• Awendaw, SC 29429 (Required)

Ability to Relocate:

• Awendaw, SC 29429: Relocate before starting work (Required)

Work Location: In person

Salary : $40