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Form of work
SalaryGENERAL SUMMARY AND PURPOSE:
To provide 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, the Clinical Resource Manager incorporates real-time contacts with medical staff, hospital personnel, and outside organizations to establish specific treatment, cost, and transition targets and to facilitate transition planning.
SKILLS, KNOWLEDGE, EDUCATION AND EXPERIENCE:
Colleague must have an RN license, as defined by their primary work state (Idaho or Oregon), issued prior to hire date. Those colleagues hired before January 1, 2020 must provide licensure or proof of application in process in their secondary state by August 28, 2020. Individuals hired in this role after January 1, 2020, must provide licensure or proof of application in their secondary state by August 28, 2020 or within six months of hire, whichever date is later.
BSN required
3-5 years of varied hospital clinical experience required. Experience in case management, home health, and/or insurance industry preferred.
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 (Neonate, Child, Adolescent, Adult, Geriatric as applicable).
Revenue Management
Ensure the accuracy of documenting services and supplies provided to the patients.
Completes a screening/assessment of physician assigned cases to determine medical necessity/status determinations and transition needs.. Reassesses, monitors, and modifies as appropriate.
Uses established criteria to determine correct level of care for acute patients entering the facility.
Performs continued stay reviews as needed and requested by third party payers and Medicaid. Responsible for appeals, denials, as appropriate.
Utilizes physician advisor referral as appropriate.
Will adhere to department established process in reviewing 30 day re-admissions.
Follows established patient choice policy.
Colleagues of Saint Alphonsus Health System enjoy competitive compensation with a full benefits package and opportunity for growth throughout SAHS and Trinity Health. Visit www.saintalphonsus.org/careers to learn more about the benefits, culture and career development opportunities available to you at Saint Alphonsus Health System.
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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 to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is 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, status as a protected veteran, or any other status protected by law.
