Our Affiliates team has a current Per Diem position that has opened .This is a great opportunity for a Nurse who wants to make some extra money or has the flexibility to cover shifts as needed. Please apply to receive a phone call and receive more details!
Implement processes for assigned panel of identified patients who would benefit from case and disease management.
Comprehensively assess patients for care opportunities and collaborate with treating physicians to develop care plans that meet patients’ needs. Improve quality of care through the most cost effective mechanisms.
Work with other providers and care teams to identify targeted patients, as well as provide patient coaching, anticipatory guidance, and condition specific education.
Collaborate with all providers on patient processes to access the appropriate level of care in the right setting. Communicate best practices to affiliated providers and their personnel to help facilitate effective clinical care and operational efficiency.
Objective: Enhance patient quality of care through reduction of avoidable admissions and emergency room utilization, and increase care to an optimal level with primary care providers and appropriate specialists.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
Responsible for quality and continuous improvement within the job scope.
Responsible for all actions/responsibilities as described in company controlled documentation for this position.
Contributes to and supports the corporation’s quality initiatives by encouraging team and individual contributions toward the corporation’s quality improvement efforts.
Works to contain health care costs and maintains high quality medical delivery system through the principles of utilization review.
Reflects Nationally Recognized Care Guidelines or Medicare Coverage Guidelines (SNF facilities) for appropriateness of admission and level of care.
Knowledgeable in HIPAA guidelines to ensure confidentiality in all aspects of communication.
Initiates and performs the discharge planning process the discharge planning process by contacting the member and/or patient designated caregiver or legal guardian to discuss the member’s discharge needs and initiate a global discharge plan.
Addresses medical and non-medical variances/quality identifies and accurately documents and reports according to company policy and procedures.
Collects accurate and timely health care data and adequately documents patient related issues (prior authorization, concurrent review, alternative care, discharge planning, referrals, high risk department) and provider related issues.
Performs onsite concurrent review as stipulated by the guidelines, policies and procedures.
Promotes alternative care programs and researches available options including costs and appropriateness of patient placement; recommends coordinates and educates patients and providers on these options.
Reviews medical records documentation throughout the inpatient stay and revises the discharge plan as indicated by the members condition; works with hospital discharge planners and social workers in early identification of potential home care candidates.
Identifies COB and/or subrogation cases.
Contacts the Inpatient Management Team, Hospitalist, Associate Medical Director or designee, as needed for unresolved issues, variances in length of stay or complex discharge needs.
Makes appropriate referrals to providers prior to discharge, including but not limited to home health care, durable medical equipment, infusion, other facilities.
Initiates State Certification (PASSAR screens) for transfers to skilled nursing facilities and long term care facilities if indicated.
Submits reports, charts, audits information and logs as required.
Performs telephonic concurrent review to long term acute, acute rehab and skilled nursing facilities, within the local service area, as assigned by manger, using the same guidelines as on-site reviews.
Knowledgeable in HIPAA guidelines to ensures confidentially in all aspects of communication.
Supports the mission, vision and values.
May be required to participate in rotation of on-call assignments.
Work with the outpatient teams to continue appropriate care coordination upon discharge. Participates in transitions of care.