Posted on Jan 24, 2019 by EMERUS
Emerus is a nationally recognized, innovative leader in the delivery of inpatient, surgical, and diagnostic medical health care. Specializing in the identification, development and management of improved-access community medical facilities, Emerus provides cost effective, scalable growth opportunities to large-scale, national health care systems throughout the United States.
By providing operationally efficient facilities and focused alignment with current health care trends, Emerus' community-based hospitals prioritize limited inpatient stays, efficient emergency rooms and cost effective pricing in a smaller campus setting. Based in The Woodlands, Texas, Emerus has more than 1,000 employees, with expert concentrations in over 20 different fields throughout the medical industry.
The purpose of this position is to provide ongoing support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. The goal of the position is to enhance the quality of patient care through innovative and cost-effective best practices. This position promotes professional growth through integration of case management, utilization review, discharge planning, denial management and patient transfer management to ensure successful continuity care. Direct experience in these areas is preferred, however training can be provided for an exceptional candidate.
- Compile, analyze, and complete daily morning patient continuum reports.
- Coordinate transfer center admission and/or transfer requests.
- Ensure compliance during all admission and transfer processes.
- Document patient outcomes during and after each coordination of care call.
- Accurately enter data into Transfer Center Database which includes but is not limited to medical, demographic and insurance data.
- Accurately document on phone recording system.
- Facilitate admission and transfer calls as required.
- Maintain patient health information privacy at all times.
- Complete and ensure Utilization Review of all admissions.
- Maintain regulatory compliance with CMS Conditions of Participation.
- Record and report extended delays in care.
- Coordinate discharge planning.
- Monitor and update discharge planning resources.
- Perform denial management responsibilities as assigned.
- Coordinate payer communication.
- Ensure patient progression through continuum of care.
- Coordination of staff scheduling assigned.
- Willingness to be a valued member on a team with an inspiring mission.
- Act as patient advocate: investigate and report adverse occurrences and perform staff education related to resource utilization, discharge planning and all other pertinent aspects of healthcare delivery.
- Collaborate with clinical staff in development and execution of the plan of care and achievement of goals.
- Minimal travel may be required
- Perform other duties as assigned.
- Bachelor's Degree, preferred
- RN licensed to practice in the State of Texas, required
- 2 years hospital clinical experience, required
- 2 years hospital Utilization Review/Case Management, preferred
- Active Case Management Certification or other professional RN Certification, preferred
- InterQual and/or Milliman experience, preferred
- Superior interpersonal skills
- Ability to establish and maintain collaborative, effective working relationships
- Ability to communicate professionally and effectively in oral, written and electronic formats
- Demonstrate analytical and critical thinking abilities with proactive decision-making and negotiating skills.
- Demonstrate professional organizational skills
- Ability to manage multiple tasks simultaneously
- Position requires fluency in English; written and oral communication.
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