Concurrent Review Specialist
2 days ago
The Concurrent Review Specialist (CRS) II is a key clinical role within the CRS Team following high risk readmissions and obtaining timely clinical updates to drive inpatient outcomes. The CRS II is responsible for quick interventions to influence discharge planning and prevent readmissions. The CRS II will serve as a liaison to the CRS Team for all readmission related topics.
The CRS II is responsible to work and collaborate with market Clinical Performance Managers, Medical Directors and Care Managers to facilitate discharge plans. The CRS II will take ownership of company-wide key performance indicators around hospital admission prevention and readmission reduction initiatives. This includes attending daily post hospital discharge visit meetings, tracking Monogram members at high-risk for readmission, and conducting telephonic outreach to facilities and members to complete targeted assessments aimed at reducing future hospitalization.
Responsibilities- Initiate and actively participate in multidisciplinary discharge rounds as needed.
- Conduct telephonic outreach to high-risk members to complete post discharge assessments, targeted disease management assessments and periodic check-ins.
- Identify, track, and follow Monogram members at high-risk for hospital admission/readmission.
- Complete Peer 2 Peer request as need and ensure that all decisions and recommendations are executed.
- Develops and collaborates with market leaders and care managers on members post discharge care transition plan.
- Support Monogram Health as necessary with any tasks or projects required to deliver excellent personalized kidney care and perform all other duties as assigned.
- The position will be located in the company's Tempe, AZ or Brentwood, TN office or within the region assigned.
- Active RN License
- 5+ years' experience in healthcare/health insurance industry, with strong preference for at least 2+ years in case management
- Excellent verbal communication skills both in person and on the phone
- Capacity to support the CRS and Operations team in promoting program development and change.
- Sharp clinical documentation skills
Comprehensive Benefits - Medical, dental, and vision insurance, employee assistance program, employer-paid and voluntary life insurance, disability insurance, plus health and flexible spending accounts
Financial & Retirement Support – Competitive compensation, 401k with employer match, and financial wellness resources
- Time Off & Leave – Paid holidays, flexible vacation time/PSSL, and paid parental leave
- Wellness & Growth – Work life assistance resources, physical wellness perks, mental health support, employee referral program, and BenefitHub for employee discounts
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person's health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders.
Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient's healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.
Monogram Health's personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
Licenses & CertificationsPreferred
- Registered Nurse
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.
-
Coding Quality Review Specialist
1 day ago
Remote, Oregon, United States MedStar Health Full time $56,000 - $110,000 per yearAbout this Job:General Summary of PositionPerforms coding quality reviews on medical recordsPrimary Duties and ResponsibilitiesContributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards. Complies with governmental and accreditation regulations.Assists with...
-
Clinical Appeals and CDI Specialist
5 days ago
Remote, Oregon, United States Managed Resources Full time $93,600 per yearClinical Appeals and CDI SpecialistFull time & Part time/RemoteCoding AID, a division of Managed Resources Inc. is a nationwide leading provider of medical coding support, coding and compliance reviews, educational programs, recruitment, revenue cycle management, and many other managed healthcare solutions. We're proud to have served healthcare organizations...
-
Behavioral Health Utilization Review RN
3 days ago
Remote, Oregon, United States Netsmart Technologies Full timeResponsible for utilization review work for emergency admissions and continued stay reviewsJob DescriptionResponsibilitiesReview and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteriaApply evidence-based clinical guidelines and criteria to assess and ensure proper...
-
Client Operations Specialist/Analyst
4 days ago
Remote, Oregon, United States ReDefined Marketing Solutions Full time $32,000 - $64,000 per yearRedefined Growth Marketing is a performance-focused digital marketing agency helping spas and med spas scale through full-funnel lead generation. We handle everything from ad strategy and campaign execution to lead nurturing, appointment booking, and retention.We're looking for a Client Operations Specialist / VA who is organized, detail-oriented, and...
-
Medical Review Clinical QA Auditor
5 days ago
Remote, Oregon, United States Performant Financial Corporation Full time $60,000 - $90,000 per yearABOUT PERFORMANT:At Performant, we're focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare,...
-
Journey Administrative Specialist
5 days ago
Remote, Oregon, United States Graham Healthcare Group Full time $50,000 - $70,000 per yearGraham Healthcare Group is hiring a Journey Patient Specialist to join our dynamic team. Journey Patient Specialist responsibilities include the day-to-day operations of Hospice's face-to-face needs. Support/assist Hospice team members to ensure face-to-face visits are assigned appropriately and completed on time. Assist the Hospice Journey team with needs...
-
Remote, Oregon, United States Datavant Full time $70,000 - $110,000 per yearDatavant is a data platform company and the world's leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format.Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health...
-
Senior Regulatory Affairs Specialist
5 days ago
Remote, Oregon, United States TruMinds Clinical Full time $104,000 - $160,000 per yearKey Responsibilities:Collaboratively interface with a variety of levels on significant matters, often requiring coordination across organizational units.Outline submission and clearance requirements in assigned geographies.Develop sound regulatory strategies in alignment with business priorities and update strategies based upon regulatory changes.Effectively...
-
Specialist II, Assessment Development
3 days ago
Remote, Oregon, United States Nightingale College Full time $80,000 - $87,000 per yearPosition SummaryThe Assessment Developer plays a critical role in designing, developing, and continuously improving valid, reliable, and secure assessments aligned with program-level outcomes and institutional learning goals. This role requires advanced knowledge of concept-based curriculum, competency-based education (CBE), and best practices in educational...
-
Billing Operations Specialist
3 days ago
Remote, Oregon, United States Medical Solutions Full time $52,000 - $104,000 per yearOverview:The Billing Operations Specialist will work in conjunction with the Billing Specialist team to manage invoice review/reconciliation and dispute resolution. The Billing Operations Specialist will be a point of contact for escalations and will act as a liaison with internal and external customers.Responsibilities:Assist as needed with weekly review of...