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Clinical Resource Manager Full-Time Days
2 months ago
Full timeShift:
Day Shift
Description:
At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.
We are looking to hire a Clinical Resource Manager for our Medical Center in Ontario, Oregon to provide hospital case management, utilization review and discharge planning
The Saint Alphonsus Medical Center - Ontario is a 49-bed, acute care, not-for-profit hospital, serving Ontario and the surrounding communities in eastern Oregon and southwestern Idaho. We are committed to providing patients the best in care, from qualified and caring staff in an environment that is comfortable and secure. At Saint Alphonsus Medical Center - Ontario, we not only provide quality care but feel it is equally important to contribute to the well-being of the community through health education, outreach programs, preventive and routine screenings, health fairs, seminars, community partnership, and more.
About Ontario: Situated on the border of Idaho and Oregon, Ontario is the gateway to arid desert beauty, stunning river canyons and towering mountain ranges. Any time of year, but especially in winter, this little town of 11,000 is a great sunny destination. As the central hub of the Western Treasure Valley, recreational opportunities are vast and varied, including cycling, hiking, golfing, fishing, kayaking, river rafting, camping, and much more Rich in culture and history, Ontario is a friendly, welcoming city and a great place to call home
About this position: 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.
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.
- 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
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.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
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. Master's degree preferred. A minimum of 2 years of varied hospital clinical experience is required. Experience in case management, home health, and/or insurance industry preferred.
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 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.
Visit Saint Alphonsus on LinkedIn, Facebook, Instagram, YouTube, and Twitter
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
