Rehabilitation Services Regional Vice President

REHABILITATION SERVICES REGIONAL VICE PRESIDENT
Nationally known Rehabilitation Services Company seeks a Regional Vice President of Operations

SUMMARY: Provision of overall management and supervision of comprehensive Regional Management, incorporating the strategies of providing quality exceptional services to our clients, while fostering a growth environment. This is accomplished by cost containment, appropriate of services, and case management in a cooperative effort with other parties which helps address the issues of access to quality healthcare services at an affordable cost. Responsible for the ongoing training, supervision and evaluation of professional staff performing Utilization Review services, including pre-admission certification, second surgical opinion, concurrent utilization review, DRG validation, as well as assessment, planning, coordination, implementation and evaluation of injured/disabled individuals involved in the medical case management process. Manages all aspects of the day-to-day operations of an individual branch; providing overall administrative, supervisory, and technical support within the office, ensuring the efficient operation and profitability of branch.
REQUIREMENTS
QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
REQUIRED EXPERIENCE:Three to five years experience in Operations/Management in the REHABILITATION SERVICES industry with multi Branch Office supervision.
- EDUCATION: Diploma, Associates Degree or Bachelor's Degree in Nursing preferred.
- Preferred EXPERIENCE: Three to Five years of clinical experience with two years of ICU, CCU or ER preferred. Prior Utilization review/quality assurance/case management/workers' compensation experience required. One year of supervisory/management experience. Prior hospital bill auditing experience preferred.
MINIMUM QUALIFICATIONS: Ability to set priorities. Excellent interpersonal skills. excellent/exceptional organizational skills. Knowledge of statistical analysis. Ability to work independently. Fully versed in state workers' compensation laws and practices. Knowledge of additional insurance lines and health benefits such as Group Health and MCO.
Preferred: CERTIFICATES, LICENSES, REGISTRATIONS: Registered Nurse with current license; reciprocal licensure in other states as required by law. CCM, CDMS, CRC, CRRN, COHN, CPUR preferred; CCM eligibility required. Pursue Case Manager Certification (CCM, CDMS, CRC, CRRN or COHN) upon eligibility. Additional professional certifications preferred.
OTHER QUALIFICATIONS: Advanced Degree preferred. Computer literacy also desirable.
ESSENTIAL DUTIES AND RESPONSIBILITIES:

A. General:

A.1 Communicate with external agencies/representatives relative to the utilization management process, including but not limited to third party administrators, insurance companies and providers.
A.2 Provide supervision to branch staff and promote growth for each employee in branch.
A.3 Uses clinical/nursing skills to assist professional staff (Nurse Reviewers, Telephonic Case Managers, Supervisors) in determining whether all aspects of a patient's care, at every level, are medically necessary and appropriately delivered, and to help coordinate the individual's treatment program while maximizing quality of care and cost containment.
A.4 Ensure that the caseload and overall branch workload is distributed appropriately.
A.5 Maintain client and project logs.
A.6 Attend scheduled meetings regarding operations.
A.7 Provide supervisors with help in hiring support staff, termination, disciplining, and documenting employees.
A.8 Hires professional staff.
A.9 Reviews individual performance evaluations and monitors wage increases to ensure proper administration of the salary program.
A.10 Coordinate staff training for orientation and provide ongoing supervision for all branch products.
A.11 Prepare weekly and month-end reports to facilitate client billing.
A.12 Review provided medical information and medical record documentation for medical necessity and appropriateness; refer for physician review as appropriate.
A.13 Report to the Regional Manager/General Manager any potential problems identified and offer possible solutions.
A.14 Establish and maintain effective working relationship with clients and the medical community.
A.15 Coordinate ongoing continuing education programs for utilization management staff.
A.16 Coordinate and perform ongoing quality assurance initiatives/programs; participation in corporate QA committee monthly meetings.
A.17 Daily management of branch operations including management of expenses.
A.18 Interact with sales staff including assisting with presentations and approval of pricing.
A.19 Monthly review of P&L statement with intervention when applicable.
A.20 Management of branch accounts receivable including processing of credit memos as needed.
A.21 Ensure data quality in branch by completing weekly edits and quality assurance reviews.
A.22 Assist in preparation of annual budgets.
A.23 Interact with legal department on all potential issues.
A.25 Ensure branch personnel are following URAC standards.
A.26 Perform other functions as requested to reach goals.
B. Professionalism: Maintaining the necessary credentials and demonstrating a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole.
B.1 Maintains professionalism at all times despite the stressful demands of the position. Capable of maintaining close relationships among all parties involved both in person and over the phone. Must be readily available for and responsive to all parties concerned.



B.2 Acquires and maintains knowledge of developments in the utilization management and medical case management fields. Keeps abreast of local workers' compensation laws and regulations, as well as other issues in the utilization management and case management fields. This is also critically important in keeping licenses and certifications valid.



B.3 Seeking professional certification and participation in professional associations keeps the Utilization Management Branch Manager informed of events in their field while establishing referral contacts.
C. Company-Wide Responsibilities: In an effort to achieve and maintain company-wide and personal standards, all employees will adhere to the policies and procedures referenced in the Employee Handbook. For the purposes of all company specific position descriptions, the more important essential, company-wide duties are condensed below:
SUPERVISORY RESPONSIBILITIES: Direct supervision of UM Supervisors and Professional Staff.

For consideration,please forward a resume and salary requirements to:
Bill Greenberg/Healthcare Recruiters International
Email: [Click here for email]