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Saint Alphonsus · 2 days ago

Clinical Resource Manager Part-Time Days

Boise, ID

Full-time, Part-time

Onsite

Entry, Mid Level

2+ years exp

Saint Alphonsus is a healthcare organization seeking a Clinical Resource Manager. The role involves providing hospital case management, utilization review, and discharge planning to ensure quality patient care and smooth transitions to the next level of care.

Health CareMedical

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

RN licenseBSNCase managementHospital clinical experienceRegulatory compliancePatient advocacyCommunication skillsMultidisciplinary collaboration

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

Preferred

Master's degree preferred

Experience in case management, home health, and/or insurance industry preferred

Company

Saint Alphonsus

Saint Alphonsus is a four-hospital regional, faith-based Catholic ministry with more than 7,000 colleagues and providers serving more than 700,000 people in Idaho and Oregon, with outreach services to Utah, Montana, and Nevada.

Founded in 1894

Boise, Idaho, USA

1001-5000 employees