Trinity Health · 9 hours ago
Clinical Resource Manager Full-Time Days
Ontario, OR
Full-time
Onsite
Entry, Mid Level
2+ years expTrinity Health is dedicated to providing exceptional service and high-quality care, and they are seeking a Clinical Resource Manager. This role involves managing hospital case management, utilization review, and discharge planning while ensuring smooth transitions for patients and families to the next level of care.
DeliveryHealth Care
Responsibilities
Provides hospital case management/utilization review and discharge planning collaboratively determining level of care needs beyond acute care, providing decision support to patients/families and physicians, managing patient and family expectations, and ensuring a smooth transition to the next level of care and services
Coordinates the integration of social services into patient care as appropriate
Coordinates the hospital activities concerned with case management/utilization review and discharge planning
Adheres to departmental goals, objectives, standards of practice, and policies and procedures
Ensures quality patient care and adheres to regulatory compliance
Provides 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
To help achieve quality clinical and cost outcomes, incorporates real-time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and to facilitate transition planning
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
Qualification
Required
Colleague must have an RN license, as defined by their primary work state (Idaho or Oregon)
IDAHO ONLY: Multistate licenses must establish residency with the Idaho Board of Nursing within 60 days from hire
All colleagues must provide licensure or proof of application in process for an Oregon RN license within 90 days of the hire date
BSN required
A minimum of 2 years of varied hospital clinical experience is required
Demonstrates knowledge and skills to competently care for all assigned age groups (Neonate, Child, Adolescent, Adult, Geriatric as applicable)
Maintains knowledge of federal, state, and private agency review requirements and regulations
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
Preferred
A master's degree is preferred
Experience in case management, home health, and/or the insurance industry preferred
Company
Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation.
10001+ employees
H1B Sponsorship
Trinity Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (8)
2024 (12)
2023 (10)
2022 (9)
2021 (7)
2020 (14)
Funding
Current Stage
Late StageTotal Funding
$0.02MKey Investors
Centers for Disease Control and Prevention
2025-10-17Grant· $0.02M
Leadership Team
Dan Drake
Trinity Health PACE President and CEO
Eileen Coogan
Pres/CEO Allegany Franciscan Ministries
Recent News
2025-09-22
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