Clinical Resource Manager

4 weeks ago

Buffalo, New York, United States Ubiquity Full time
Job Description

Are you a seasoned Registered Nurse with a passion for shaping the future of healthcare?

As a Clinical Resource Manager, you will be responsible for an assigned caseload at acute and post-acute care facilities. You will conduct in-person, on-site, face-to-face outreach, with patients to introduce the Post-Acute program. You will gather patient demographics and collaborate with hospital clinicians, patients and their family to develop a discharge plan of care and will coordinate post-acute care services for the patient and collaborate with Post-Acute homecare agencies on post-acute care plan of care, authorizing services as medically necessary.

The Post-Acute Care program helps to reduce hospital readmissions of patients and has aspects of education and coaching to assist patient's transition home after a hospital stay. The program works directly with patient treatment plans, facilitates in home health care services to accomplish the treatment plan, patient goals and patient education/coaching along with adherence/compliance monitoring.

Key Responsibilities:

  • Determine the optimal site of care for patients post hospital discharge in collaboration with hospital discharge planners, case managers and hospitalist.
  • Manage and influence the transition of assigned Post-Acute Care patients from acute care setting to the SNF, IRF, LTACH or home setting utilizing face to face and/or telephonic outreach.
  • Facilitate home health physician orders for home care upon a patient's discharge to home.
  • Contact referral sources to advise and relay updates to the appropriate individuals.
  • Partner closely with the PAC Medical Director in reviewing discharge plans and length of stay status to ensure optimal outcomes.
  • Communicate customer service/provider issues to supervisor for logging and resolution.
  • Engage and coach the patients/caregivers for performing standard assessments, patient care plans, and document progress in the HomeBridge platform.
  • Document all interactions, problems, goals and interventions to meet documentation guidelines.
  • Work closely with the home health agency nurse to facilitate education and adherence to establish health care goals and care plan.
  • Act as a clinical resource for unlicensed staff, to provide clinical expertise and help with referral source directives, clinical questions and issues.
  • Participate and contribute to ongoing quality assessment/improvement activities, performance, data collection, analysis, operational process activities and prepares reports.
  • Assist team in implementing and maintaining standardized operational processes to ensure compliance to company policies, legal requirements and regulatory mandates.

Requirements:

  • You hold a current and unrestricted Registered Nurse license.
  • You have a minimum of five years RN experience, preferably with a geriatric population.
  • You are an expert in Utilization Management and have knowledge of URAC and NCQA standards.
  • You have a broad knowledge of health care delivery/managed care regulations, contract terms/stipulations, prior utilization management/case management experience, and governmental home health agency regulations.
  • You possess negotiation, communication, influencing, problem-solving, and decision-making skills.
  • You possess high-level clinical knowledge, communication, customer service, and problem-solving skills, as well as the ability to effectively interact with all levels of management and a highly diverse clientele.
  • You have excellent communication, organizational, and interpersonal skills and are able to effectively manage and prioritize tasks.

What We Offer:

  • Full range of benefits including Health, Dental, and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
  • Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training, and more.
  • Advancement opportunities, professional skills training, and tuition reimbursement.
  • Great culture with a sense of community.

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