Address
Form of work
SalaryCollaborate with and serve as an expert resource to the health care team to enhance the delivery of patient care services. Efficiently coordinate patient needs to assure high quality patient care, reduce length of stay and resource utilization and ensure reimbursement drawing on a broad clinical and systems management knowledge base.
Responsibilities
• Collaborate with the medical staff and serve as a resource expert regarding documentation, application of appropriateness criteria, alternate levels of care, patient classification, and denial information. • Keeps the medical record current. • Initiates collaborative action towards identified barriers to quality. • Communicates with physicians and payers to avoid medical necessity denials. • Performs clinical review on each case to provide payer with information related to level of care required and reimbursement. • Facilitates group process and interdisciplinary problem solving. • Works with physicians to obtain level of care orders. • Notifies and arranges peer to peer with payer when applicable. Documents follow in patient's record. • Integrates continuous, quality improvement into department and institution operations, and demonstrate a commitment to the process.
Knowledge, Skills & Abilities
Patient Group Knowledge (Only applies to positions with direct patient contact) The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department’s identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients. Competency Statement Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist. Common Duties and Responsibilities (Essential duties common to all positions) 1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.
Education
• Bachelor's Degree (Required) Education: Or related degree Experience: 5 yrs Clinical Experience and 2 yrs Experience Pertinent to Position Substitution: Associates Degree and 9 Years Relevant Experience May be Substituted for Bachelors degree and 7 years experience.
Credentials
• Registered Nurse (Required)
Work Schedule: Days
Status: Full Time Regular
Location: General Hospital
Location of Job: US:WV:Charleston
Talent Acquisition Specialist: Lauren R. Lane lauren.lane@vandaliahealth.org
