Weekend Utilization Review Jobs in Oregon (NOW HIRING)

Employment Type:Part timeShift:Day ShiftDescription: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.

CLINICAL RESOURCE MANAGER

BAKER CITY, Part-time

GENERAL SUMMARY AND PURPOSE:

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.

SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:

• Colleague must have an RN license in Oregon.

• IDAHO ONLY: Multistate licenses must establish residency with the Idaho Board of Nursing within 60 days from hire.

• All colleagues must provide licensure or proof of application in process for an Oregon RN license within 90 days of the hire date.

• BSN required. A master's degree is preferred.

• A minimum of 2 years of varied hospital clinical experience is required.

• Experience in case management, home health, and/or the insurance industry preferred.

HOURS AND ENVIRONMENT: You will have outstanding work-life balance as this position requires two days a week, with Wednesdays required. The hours will be 7am-3pm. No weekends. No evenings. No holidays. The position is in small, close-knit, supportive, critical access hospital.

ESSENTIAL FUNCTIONS:

• Knows, understands, incorporates, and demonstrates the Organization's Mission, Vision, and Values in behaviors, practices, and decisions.

• Demonstrates knowledge and skills to competently care for all assigned age groups.

• 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 cllaborative 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,

Highlights and Benefits:

When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.

• We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.

• Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.

• We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.

Ministry/Facility Information:

Saint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 90 ambulatory locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus' goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.

• Top 15 Health Systems in the country by IBM Watson Health;

• The region's most advanced Trauma Center (Level II);

• Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life

Saint Alphonsus and Trinity Health are committed to promoting diversity in its workforce and to providing an inclusive work environment where everyone is treated with fairness, dignity and respect. We are committed to recruit and retain a diverse staff reflective of the communities we serve. Saint Alphonsus and Trinity Health are equal opportunity employers and prohibit discrimination against any individual with regard to race, color, religion, gender, marital status, national origin, age, disability, sexual orientation, or any other characteristic protected by law.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.