Manager of Clinical Care Coordination, DME Respiratory

Who we are

IHCS provides an Integrated Delivery System in the home setting, which includes DME, Respiratory, Home Health, and Home Infusion services. We have a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1. With over 15 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services.

What You Will Be Doing

• Provides leadership, direction, and oversight to Clinical Care Coordination and Utilization Management staff supporting DME services.
• Recruits, onboards, trains, manages, coaches, disciplines, and reviews compensation for Clinical Care Coordination and Utilization Management staff.
• Oversees clinical review and authorization workflows for DME respiratory services, including CPAP, BiPAP, non-invasive ventilation, and invasive ventilators.
• Ensures timely, compliant, and medically appropriate authorization decisions in accordance with CMS turnaround time (TAT) requirements for both urgent and standard requests.
• Monitors TAT performance, escalates risks, and implements corrective actions to maintain compliance.
• Ensures accurate application of medical policies, benefit plans, and clinical criteria when making coverage determinations.
• Facilitates effective communication with providers, DME vendors, home health agencies, and payers regarding authorizations, denials, documentation requests, and care coordination needs.
• Analyzes productivity, quality, cost, denial, and TAT reports to identify trends and improvement opportunities.
• Supports audits, regulatory reviews, and corrective action plans as needed.

Qualifications

• Active FL Respiratory Therapist (RT) License
• Bachelor's degree in Nursing (BSN), Respiratory Therapist (RT), Healthcare Administration, or a related field (Master’s degree preferred)
• Minimum of 3–5 years of experience in utilization management, case management, or a related healthcare setting
• At least 2 years of leadership or supervisory experience in a healthcare environment
• Strong understanding of utilization management, medical necessity criteria, and regulatory compliance (e.g., CMS, NCQA, URAC)