- Acts as senior-level liaison and subject matter expert in matters concerning Medical Review policies, processes, and systems related to Program Integrity Audits for the ProMedica Hospice and Home Care Division of Senior Care.
- Works in conjunction with the Legal Department and Outside Counsel under Attorney Client Privilege as needed in the execution of Program Integrity Medical Review Audits.
- Attends operations meetings at the request of the GMs and RDOs.
- Responsible for hiring, training, and effectiveness of Senior Care Medicare Ops Specialists.
- Executes divisional and regional coverage plan and manages resources to assure that Program Integrity Audits and Medical Reviews are standardized at each location.
- Responsible to prepare quarterly reporting using standardized measures of Medical Review established by the VP and AVP of the department.
- Identify key Medical Review and Program Integrity trends in clinical operations of Agencies.
- Consistently reviews and evaluates the quality of overall patient care documentation of ProMedica Hospice and Home Care Agencies. Recommends and performs training and education plans throughout the division.
- Consistently reviews and evaluates the effectiveness of Medicare Operations Specialist tools used in the monitoring, tracking, reporting, documenting, and escalating of key clinical documentation issues
- Maintains records of all engagements, and visits to the business units and/or with the business customer and reports outcomes in a standard format to the AVP. 1
- Stays abreast of developments in Program Integrity and Medicare Conditions of Participation, directives, new focus, best practices, systems and technologies that impact Medical Review documentation and acts as a conduit for disseminating this knowledge throughout their teams and operational constituencies.
- Performs all other duties as assigned.
-
Full Time Veterinarian
1 week ago
Lap of Love Toledo, United States Full timeLife is HAPPIER at Lap of Love Join Lap of Love as an In-Home, Associate Veterinarian in Omaha · Are you ready for a change of pace from in-clinic practice? Looking to reconnect with pet families and provide the kind of service you'd always envisioned by having generous appointme ...
-
Full Time
3 weeks ago
Lowe's Companies, Inc. Toledo, United States Full timeWhat You Will Do · All Lowe's associates deliver quality customer service while maintaining a store that is clean, safe, and stocked with the products our customers need. As a Back-End Clerk, this means: · * Meeting the customer needs during a return and helping find the correct ...
-
Psychiatrist (FULL TIME)
3 weeks ago
Ohio Department of Developmental Disabilities Toledo, United States Full timePrimary Location · :United States of America-OHIO-Lucas County-Toledo Work Locations · :Northwest Ohio Psych Hosp930 South Detroit AvenueToledo Organization · :Mental Health & Addiction Services - Northwest Ohio Psychiatric HospitalClassified Indicator:ClassifiedBargaining ...
-
Full Time Cashier
4 weeks ago
HomeBuys Toledo, United States Full time**Full Time Cashier - Toledo** · Toledo, OH · Full-Time · Customer Service · Full Time Cashier - Toledo · **General Job Description:** · We are looking for an efficient, courteous Full Time Cashier who possesses excellent customer service skills. The Full Time Cashier will ...
-
Full Time Pediatrics
3 weeks ago
Enterprise Medical Recruiting Toledo, United States Full timeEnterprise Medical Recruiting is assisting a non-profit health system in Findlay, Ohio with the recruitment of a full-time BC/BE Pediatrician to join their inpatient team. · Opportunity Highlights · Full-time is six, 24-hour shifts in a 28-day block · Provide newborn care (32+ we ...
-
Psychiatrist (FULL TIME)
2 weeks ago
State of Ohio Toledo, United States Full timeThe mission of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is to provide statewide leadership of a high-quality mental health and addiction prevention, treatment and recovery system that is effective and valued by all Ohioans. · Mission · Advancing Reco ...
-
Full Time Counselor
3 weeks ago
Zepf Toledo, OH, United States Full timeZepf Center has been serving the Lucas County community for nearly 50 years. We are the leading provider of behavioral health and substance use disorder services in Northwest Ohio. Services include adult and child psychiatric, substance abuse, case management, residential, Crisis ...
-
Psychologist - FULL TIME
2 weeks ago
State of Ohio Toledo, United States Full timeThe mission of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is to provide statewide leadership of a high-quality mental health and addiction prevention, treatment and recovery system that is effective and valued by all Ohioans. · Mission · Advancing Reco ...
-
Full Time Counselor
3 days ago
Zepf Toledo, OH, United States Full time: Zepf Center has been serving the Lucas County community for nearly 50 years. We are the leading provider of behavioral health and substance use disorder services in Northwest Ohio. Services include adult and child psychiatric, substance abuse, case management, residential, Cris ...
-
CRNA Full Time with
3 weeks ago
NorthStar Anesthesia Toledo, OH, United States Full timeRapid Growth, Endless Opportunities · As NorthStar continues to grow across the country, we're looking for passionate clinicians to join our mission of excellence in anesthesia care. Discover rewarding opportunities at over 200 healthcare facilities, where you'll not only receiv ...
-
Psychiatrist (FULL TIME)
3 weeks ago
Ohio Department of Commerce Toledo, United States Full timeThe mission of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) is to provide statewide leadership of a high-quality mental health and addiction prevention, treatment and recovery system that is effective and valued by all Ohioans. · Mission · Advancing R ...
-
Caregiver (Full-Time)
2 weeks ago
Visiting Angels Living Assistance Services Toledo, United States Full time[Patient Care / Health Aide] W Central Ave #A - As a Caregiver you'll: Assist individuals with a range of daily activities beyond personal care; Offer emotional support and companionship; Help individuals with tasks such as bathing, shampooing, combing hair, brushing teeth, shavi ...
-
Full Time Teller
2 weeks ago
PNC Financial Services Group, Inc. Toledo, United States Full timePosition Overview · At PNC, our people are our greatest differentiator and competitive advantage in the markets we serve. We are all united in delivering the best experience for our customers. We work together each day to foster an inclusive workplace culture where all of our emp ...
-
full time delivery driver
1 week ago
Chief Delivery LLC Toledo, United States Full timeBecome a Delivery Associate / Driver with Chief Delivery · No previous work experience required. · Compensation: $ $21.00 Per Hour · Weekly Bonus Opportunities Available · Paid Time Off (PTO), Medical & Dental Benefits Available, Accident Insurance Provided · 401-K Program with E ...
-
Cook Full Time
3 weeks ago
Salvation Army - ARC Toledo, United States Full timeJob Description · Job DescriptionThe Salvation Army's Adult Rehabilitation Centers make a difference in people's lives. Through the collection and resale of gently used goods we are able to provide the financial support to assist men and women with a variety of social and spiritu ...
-
Cook Full Time
1 week ago
Salvation Army - ARC Toledo, United States Full timeJob Description · Job DescriptionThe Salvation Army's Adult Rehabilitation Centers make a difference in people's lives. Through the collection and resale of gently used goods we are able to provide the financial support to assist men and women with a variety of social and spiritu ...
-
phlebotomist - full time
2 weeks ago
Toledo Clinic Toledo, United States Full timeJob Description · Job DescriptionGeneral Summary:Performs Venipuncture and capillary puncture on patients. Travels between Toledo Clinic Laboratories as needed. · Works under the supervision of the Phlebotomy Supervisor. · Principal Duties & Responsibilities: · Example of Essenti ...
-
General Dentist Full-Time
2 weeks ago
Mid America Health Toledo, United States Full timeJob Description · Job Description$10,000 Sign-On Bonus Available · Full-Time General Dentist Job Opportunity Description: · Mid America Health is currently seeking a Full-Time General Dentist to join our growing team This position is 4-5 days per week (Monday-Friday only; approx. ...
-
Full time Flexible Nanny
1 week ago
Jovie of Michigan Toledo, United States Full timeJovie Nannies + Sittersis searching for caring, energetic, cheery, and dedicated Full-time Flex Nannies to adopt their I can do motto when it comes to being a positive beacon in the lives of children. Do you have the ability to engage and connect with children? Are you always han ...
-
Security Officer Full Time
1 week ago
Allied Universal® Toledo, United States Full timeJob Description · Job DescriptionOverviewAllied Universal, North America's leading security and facility services company, provides rewarding careers that give you a sense of purpose. While working in a dynamic, diverse and inclusive workplace, you will be part of a team that fue ...
Director - Medical Review / Program Integrity - Senior Care Ops - Full Time - Toledo, United States - ProMedica
Description
Job TitleDirector - Medical Review / Program Integrity - Senior Care Ops - Full Time
Category
Business Administration and Operations Management
Organizational Unit
ProMedica -> ProMedica System -> Bus Ofc and Clinical Support
Location
Toledo, OH 43604 US (Primary)
Job Description
Position Summary:
ProMedica Home Health and Hospice has significant financial exposure for Fraud & Abuse / Program Integrity audits. The Agencies prepare the records for submission in conjunction with ProMedica revenue cycle staff.
This position does review, follow-up, and works directly with CMS and it's contractors in conjunction with the Reimbursement AVP and Assistant General Counsel to resolve issues and minimize paybacks.
Accountabilities:
*All duties listed below are essential unless noted otherwise
Education:
Bachelor's degree in Nursing or RN with equivalent experience.
Skills:
Strong background in Medical Review and Program Integrity. Excellent interpersonal, presentation, and communication skills. Proven problem-solving skills and the ability to be solution-oriented. Ability to conduct clinical training in group and individual settings. Ability to work with individuals of diverse backgrounds and operate effectively under pressure. Working knowledge of ProMedica Senior Care Hospice and Home Health Care applications and Microsoft Office software. Experience in managing, and holding staff accountable, as well as consulting at the senior manager and director levels.
Years of Experience:
Minimum ten years experience
License:
RN or equivalent professional license
Certification:
N/A
ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit
Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category.
Equal Opportunity Employer/Drug-Free Workplace
Employee Exemption Type
Exempt
Job Type
Full Time
Budgeted Hours / Pay Period
80
Shift Type
Days
Shift Hours
Weekends
On-call Requirements
Additional Schedule Details
