New job RN Clinical Resource Manager Full-Time Days in Idaho
RN Clinical Resource Manager Full-Time Days
Company : Saint Alphonsus Health System
Salary : Details not provided
Location : Idaho
We are seeking a Full-Time RN Clinical Resource Manager to provide hospital case management, utilization review and discharge planning – working collaboratively to determine the appropriate level of care needs beyond acute care. You will also provide decision support to patients/families and physicians, while managing patient and family expectations, and ensuring a smooth transition to the next level of care and services.
In this role, you will provide concurrent assistance and support to physicians and other clinical members of the health care team in coordinating the delivery of services for a select group of patients. Your goal is to help achieve quality clinical and cost outcomes, incorporating real-time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and to facilitate transition planning.
Colleague must have an RN license, as defined by their primary work state (Idaho or Oregon), issued prior to hire date.
Must provide licensure or proof of application in their secondary state (Idaho or Oregon) within six months of hire
BSN or bachelor's degree in a related healthcare field required. Master's degree preferred.
Minimum of 2 years of varied hospital clinical experience required. Experience in case management, home health, and/or insurance industry preferred.
Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.
Demonstrates knowledge and skills to competently care for all assigned age groups (Neonate, Child, Adolescent, Adult, Geriatric as applicable).
Revenue Management: ensures the accuracy of documenting services and supplies provided to the patients.
Coordinates the integration of social services/case management functions into patient care, discharge, and home planning process with other hospital departments, external service organizations, agencies and healthcare facilities.
Completes a screening/assessment of physician assigned cases to determine medical necessity/status determinations and transition needs. Reassesses, monitors, and modifies transition needs as appropriate.
Conducts concurrent medical record review using established medical necessity criteria to determine correct level of care for acute patients. Assists physicians with completing transfer and discharge orders. Maintains knowledge of federal, state, and private agency review requirements and regulations.
Provides education to all health care team members including physicians regarding requirements to meet regulatory standards.
Promotes effective and efficient utilization of clinical resources from admission to discharge.
Initiates and presents "denial letters" as appropriate. Completes PASRRs for admission to skilled nursing facilities. Delivers Condition Code 44 letters to patients and educates them on Medicare benefits.
Researches and locates resources for patients for example: assistance in competing medication applications for financial assistance through pharmaceutical companies, works closely with our Patient Financial Advocates in the Medicaid pending process, and works closely with outside facilities to obtain equipment in situations when patients have limited funding available to them.
Communicates with physicians at regular intervals throughout hospitalization and develops an effective working relationship. Assists physicians to maintain appropriate cost, cases, and desired patient outcomes.
Introduces self to patient and family and explains clinical resource manager role and the process for patient and family to contact clinical resource manager.
Serves as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions.
Participates in multidisciplinary patient care rounds and/or conferences as appropriate to review treatment goals, optimize resource utilization, provides family education and identification of post-hospital needs.
Utilizes physician advisor referral as appropriate.
Adheres to department established process in reviewing 30 day re-admissions.
Follows established patient choice policy.
Documents assessment of primary and back up plans along with communications to patient, family and care team.
Documents interventions taken to meet the needs of their individual patients in Power Chart.
Actively participates in department staff meetings and department sub teams.
Ensures discharge planning compliance with Medicare Conditions of Participation/regulations and Joint Commission standards
About Saint Alphonsus:
Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health.
Visit www.saintalphonsus.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Alphonsus Health System.
Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs about 133,000 colleagues at dozens of hospitals and hundreds of health centers in 22 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.