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Patient Resource Manager

2 months ago

Abingdon, Virginia, United States Ballad Health Full time
About the Role

**Job Summary:**

We are seeking a highly skilled and experienced RN - Patient Resource Manager to join our team at Ballad Health. As a key member of our clinical operations team, you will be responsible for coordinating services, programs, and personnel to maximize patient outcomes and quality care.

Key Responsibilities
  • **Clinical Assessment and Intervention:**
    • Oversee the care provided to assigned patient populations, ensuring exceptional clinical assessment and intervention skills.
    • Review patient status daily and identify issues requiring intervention.
  • **Collaboration and Communication:**
    • Anticipate, plan, and discuss patient needs with patients, families, physicians, interdisciplinary teams, and third-party payers.
    • Ensure a collaborative and team approach to patient care, minimizing delays in care delivery and ensuring positive outcomes.
  • **Data Collection and Analysis:**
    • Collect and analyze data to identify opportunities for improvement in service delivery.
    • Assist in improving the efficiency and effectiveness of services when appropriate.
  • **Clinical Documentation:**
    • Oversee clinical documentation in assigned patient groups, ensuring completeness and accuracy.
  • **Payer Relations:**
    • Ensure ongoing communication and collaboration with payer sources, achieving appropriate pre-certification and ongoing concurrent certification.
    • Apply various payer rules and regulations, admission, discharge, and continued stay reimbursement criteria, and Interqual and Milliman Guidelines.
  • **Discharge Planning:**
    • Oversee the discharge planning process, including plan development, implementation, education, and acquisition of resources for a successful discharge.
  • **Utilization Review:**
    • Utilize patient care protocols and clinical pathways, ensuring appropriate patient and family education prior to discharge.
Requirements
  • **Education:**
    • Associate's or Bachelor's degree from an accredited Nursing program.
  • **Experience:**
    • Varied clinical experience.
    • Experience in Quality, Case Management, Utilization Review, or similar field is preferred.
  • **License and Credentials:**
    • Valid and active RN licensure in the appropriate state.
Work Requirements
  • **Shift:**
    • Rotating.
  • **On Call:**
    • No.
  • **Weekends:**
    • Rotating.
  • **Travel Required:**
    • No.