Clinical Resource Manager Boise PRN Rotating Shift, Rotating Weekends/Holidays

Department:

ID101_65510 Clinical Resource Mgt

Expected Weekly Hours:

Shift:

Rotating Shift

Position Purpose:

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.

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.

Job Description Details:

Skills, Knowledge, Education & Experience:

* Licensed in the State of Idaho or the State of Oregon as a Registered Nurse as defined by the State Board of Nursing in the state of assignment required.

* BSN or bachelor's degree in a related healthcare field required. Master's degree preferred.

* Minimum of 2 years of varied hospital clinical experience required. Experience in case management, home health, and/or insurance industry preferred.

* American Heart Association Basic Life Support for HealthCare Provider (BLS/HCP) certification required

* Strong interpersonal and communication skills, both verbal & written.

* Demonstrated leadership skills, independent problem solving and decision making abilities.

* Ability to handle multiple tasks and high volume of work.

* Must possess an aptitude for learning new computer applications.

* Intermediate computer skills with an emphasis on MS Word & Excel.

Essential Functions:

* Meets Health System's Guiding Behaviors and Caring Standards including interpersonal communication and professional conduct expectations.

* Demonstrates knowledge and skills to competently care for all assigned age groups (Neonate, Child, Adolescent, Adult, Geriatric as applicable).

* Revenue Management: ensures the accuracy of documenting services and supplies provided to the patients.

* 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.

Trinity Health's Commitment to Diversity and Inclusion

Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 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.