Utilization Management Lead — Patient Care & Compliance

Affinity Home Health Care Inc; Mableton (GA); On-site; USD 110,000 - 160,000; Full time

Job summary

Affinity Home Health Care Inc. seeks a leadership professional to oversee the Utilization Management program, ensuring quality patient care and regulatory compliance. You will manage staff, finances, and operations, collaborating with physicians and departments to optimize outcomes and throughput.

The role emphasizes developing standards, tracking data for improvement, and representing the program in professional settings, while staying current with industry developments.

Qualifications

• Bachelor’s or Master’s degree in Nursing (RN) with active RN licensure.
• Minimum 3 years hospital-based case management and multidisciplinary staff management.
• Strong communication and interpersonal skills with the ability to multitask.

Responsibilities

• Promote a positive environment for patients, families, staff, and community, fostering teamwork and professional communication.
• Coordinate patient care, assessing trends, updating standards, and ensuring adherence to best practices and compliance with regulatory and payer requirements.
• Serve as clinical resource, developing educational materials, facilitating case management, and tracking data for continuous improvement.
• Manage utilization review activities, analyze reports, and ensure compliance with CMS and commercial payor standards.
• Assist in budget development, monitor expenses, and promote cost-effective utilization services.
• Ensure regulatory compliance by developing standards, monitoring staff adherence, and participating in relevant committees.
• Represent the program professionally at meetings and through publications, staying current with industry developments.

Skills

Strong communication

Interpersonal skills

Multitasking

Education

Bachelor’s or Master’s degree in Nursing (RN)

Job description

Affinity Home Health Care Inc. seeks a leadership professional to oversee the Utilization Management program, ensuring quality patient care and regulatory compliance. You will manage staff, finances, and operations, collaborating with physicians and departments to optimize outcomes and throughput.

The role emphasizes developing standards, tracking data for improvement, and representing the program in professional settings, while staying current with industry developments.