Milliman Jobs in Ohio (NOW HIRING)

Job Qualifications (Knowledge, Skills, and Abilities)

 Current license to practice as a registered nurse in the State of Ohio, or a licensed independent social worker. LCDC III or LSW is acceptable if working in the Substance Abuse Program.

 Prefer 2 years utilization review, discharge planning, case management or medical social work experience.

 Strong organization skills, self-directed, flexible, able to adapt to rapidly changing regulatory requirements.

 Possesses excellent clinical assessment and analytical skills.

 Possesses good computer skills.

 Possesses effective interpersonal skills, can work across departmental boundaries, facilitates problem resolution, and maintain a professional demeanor in difficult situations.

 Knowledge of the functional operations of utilization management, discharge planning, business office and third party payers preferred.

 Possesses excellent verbal and written communication skills.

 Willing to take call in order to meet the needs of the department.

Job Relationships

Reports to: Clinical Manager, Assistant Clinical Manager/Educator, Charge Nurse or designee.

Supervises: May provide clinical supervision to other staff as assigned. Job Responsibilities Essential Responsibilities:

 Exhibits the Service Excellence Behavior Standards: Role modeling excellence for all to see. Provides updates and initiates service recover on identified issues. For example: demonstrates friendliness and courtesy, effective communication creates a professional environment and provides first class service.

 Case Coordination - Assesses, plans, evaluates, and coordinates management of patient care including discharge planning, and utilization needs as written under the utilization program in the administrative policy, and psychosocial concerns. Coordinates with the multi-disciplinary team in meeting these goals. Conduct face-to-face medical necessity assessment when appropriate. Actively use InterQual/Milliman criteria to evaluate each patient. Determine level of care and inform physician before written orders, using InterQual/Milliman criteria. Document assessment and primary and backup plans for each patient and communicate to patient, family and health care team and update daily.

 Continuity Planning - Identifies discharge needs, coordinates planning, and problem solves continuity Issues to ensure seamless continuum of patient care. Assures appropriate clinical information is provided to outside agencies.

 Collaboration - Collaborates with the multi-disciplinary team, including physicians and other healthcare disciplines, and outside agencies regarding patient stay management and payment issues. Initiates appropriate consults, e.g., physician and other ancillary services.

 Communication - Communicates pertinent information, including clinical, psychosocial, and utilization to appropriate members of the patient care team. Keeps patient/family/payer/physician appraised/updated. Communicates specific issues to medical advisor and hospital leadership as appropriate, including discharge delay and inappropriate utilization.

 Initiative - Takes responsibility to identify and eliminate barriers to effective patient stay management Case Manager SW Page 2 of 3 and promotes improvements in work processes within department, hospital, and community. Responsible/accountable for professional development and maintaining licensure. Takes ownership for self-education and education at area meetings. Assists in maintenance of departmental compliance with continuous regulatory readiness.

 Advocacy - Advocates for patient legal, social, and ethical rights while balancing patient resources and hospital financial stewardship. Refers quality issues to appropriate source.

 Education - Coordinates/facilitates patient/family education. Educates hospital leadership and staff to current case management practices, patient coordination issues, and unit specific trends, including formal in-services.

 Consultation - Provides consultation to professional staff and employees regarding patient stay options, financial considerations, psychosocial concerns, risk management, and ethical issues.

 Documentation - Accurately and completely documents pertinent assessments, interventions and outcomes for patients in accordance with documentation standards, policies, procedures and/or guidelines.

 Computer Skills - Utilizes computer systems effectively, systems appropriate to area and Registrar. Appropriate use of internet and Intranet.

 Exhibits each of the Diley Ridge Service Excellence Behavior Standards, role modeling excellence for all to see. For example, demonstrates friendliness and courtesy, effective communication, creates a professional environment and provides first class service.

 Delegation: Accepts responsibility for the direction of co-workers and support staff in the implementation of patient care.

Other Job Responsibilities:

 Participates in the performance improvement activities. Attends in-service programs and other activities to promote professional growth and enhance knowledge in the field of case management.

 Attends and actively participates in staff meetings, participates in committees as requested.  Provides orientation of other case managers as requested.  Responsible for compliance with Organizational Integrity through raising questions and promptly reporting actual or potential wrongdoing.

 Fulfills on-call coverage requirement and participates in weekend and holiday rotation as needed.

 Participates in and coordinates with organizational process to collect and evaluate information about hazards and safety practices that are used to identify safety management issues. Adheres to established policies and procedures, which may include wearing of personal protective equipment.

 Participates in and fosters a performance improvement approach that includes both intradepartmental and interdepartmental activities.

 Exhibits a customer service and community focus.

 Fosters a climate that will assist Diley Ridge Medical Center to fulfill its mission.

 All other duties as assigned.

Our Commitment to Diversity and Inclusion
 

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 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.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.