Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.
- Demonstrates desired results in achievement of all relevant strategic, budgetary and operational targets and objectives including revenue, expense, utilization and quality indicators.
- Works with clinical supervision to ensure that patient care meets established quality and utilization standards, and complies with federal, state, and local regulations
- Compiles and analyzes data, prepares statistical reports related to quality and utilization issues as directed and makes recommendations for quality improvement activities.
- Supports the performance of clinical teams through initiation and facilitation of quality improvement projects and staff education
- Reviews clinical documentation to ensure acceptable standards of clinical practice and reimbursement, as well as compliance with regulatory guidelines. Reviews physician orders for technical and clinical accuracy and appropriateness
- Responds to queries and denials of payment (Medicare, Medicaid, BCBSM or other payers), and participates in audits and surveys as directed.
- Recommends write-offs to the billing department or Finance Director.
- Maintains current knowledge of all institutional, state and federal policies and regulations (Federal, MDCIS, Medicare, Medicaid, BCBSM) as it relates to the utilization of services and acts as a resource for department personnel in this area
- In conjunction with the clinical supervisors, participates in orientation of staff regarding Conditions of Participation, third party coverage and other insurance coverage issues and its proper documentation.
- Monitors new staff utilization of services for a designated period of time to ensure appropriate utilization of services
- Provides regular audit reports regarding quality improvement, utilization, and compliance activities to the Quality Manager
- Keeps upper management, supervisors and staff knowledgeable regarding the state of utilization patterns within the department
- Assists in the planning, organization, implementation, evaluation and supervision of student training and provision of care and services.
- Participates in development and ongoing review of the Quality Assurance and Performance Improvement program (QAPI). Ensures priority initiatives are addressed timely.
- Participates in accreditation survey readiness activities and the survey process. Participates in organization sponsored inservice training.
- Patient and Family Centered Care
- Actively engages the patient, patient representative (if any), and family, as applicable, by exhibiting respect and dignity, sharing information in a timely and unbiased manner, and welcoming and encouraging participation to achieve shared decision making
- Collaborates with other members of the team, including the patient, patient representative (if any), and family to achieve the ideal patient care experience.
- Practices within the scope of license, certification, or registration.
- Complies with all applicable continuing education requirements.
- Complies with all University of Michigan and departmental standards and expectations.
- Supports the department's commitment to lean thinking principles and to continuous improvement activities, and contributes positively and respectfully to all problem-solving and change processes at Home Care Services.
- Performs other duties as assigned.
This position is responsible for participating in and leading quality improvement activities based on quality data and evidence-based practice; monitoring the utilization of all professional home health services as provided by MVN/MVC clinical staff; keeping upper management, supervisors and staff informed regarding utilization patterns within the department; and collaborating with the staff educator to ensure staff competency related to clinical practice and documentation requirements.
- Previous home health care Quality Improvement (QI) and/or Utilization Review (UR) experience
- Bachelor's Degree in Nursing or Occupational Therapy, or Master's Degree in Physical Therapy
- Current licensure as a Registered Nurse or Physical Therapist, or certification as an Occupational Therapist, in the State of Michigan
- One year of experience in Medicare certified home health agency
Michigan Medicine is one of the largest health care complexes in the world and has been the site of many groundbreaking medical and technological advancements since the opening of the U-M Medical School in 1850. Michigan Medicine is comprised of over 30,000 employees and our vision is to attract, inspire, and develop outstanding people in medicine, sciences, and healthcare to become one of the world?s most distinguished academic health systems. In some way, great or small, every person here helps to advance this world-class institution. Work at Michigan Medicine and become a victor for the greater good.
What Benefits can you Look Forward to?
- Excellent medical, dental and vision coverage effective on your very first day
- 2:1 Match on retirement savings
Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes.
2850 South Industrial Highway, Ann Arbor, MI 48104
Physical Requirements: The employee will be able to perform the assigned duties and responsibilities with or without reasonable accommodations: ability to work in a sedentary position for long periods of time, ability to communicate/ exchange information, fine motor coordination/dexterity necessary for keyboarding or typing, and may require reaching, bending, twisting, stooping, moving about, lifting of up to 10 pounds, etc., with or without the use of assistive/adaptive devices.
Staff may carry out assignments in patient's homes, hospitals, clinics and HCS offices. Staff may drive personal or University owned vehicle and walk on uneven surfaces to these various work site locations in all weather conditions on a regular basis.
Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.
The University of Michigan is an Equal Opportunity Employer. We are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants, including protected veterans and individuals with disabilities.
