Aultman Health Foundation Job - 31210806 | CareerArc
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Company: Aultman Health Foundation
Location: Canton, OH
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech

Description

PURPOSE OF POSITION:

Collaborate with the RN Case Managers, Social Workers, and Precertification/Verification staff to provide necessary clinical information to external payers to ensure services and interventions are timely and appropriate in meeting the needs of the patients along with fulfilling financial responsibilities.

WORKING CONDITIONS:

  1. Works 8 hours per day, adjusting hours to meet customer needs. Includes weekend/holiday rotation.
  2. Must be in good physical and mental health and maintain an excellent attendance record
  3. Must adhere to Hospital policies and procedures
  4. Must fulfill position description requirements
  5. Is subject to frequent interruptions during performance of duties
  6. Hazardous Exposure Category – 1
  7. Must be able to utilize computer/word processing

QUALIFICATIONS:

  1. Graduate of approved School of Nursing, BSN, or college courses preferred
  2. Current licensure in the State of Ohio
  3. Five years experience in the acute care setting
  4. Certification in UR, Case Management, Quality, or related field preferred
  5. Refined communications skills, both written and oral
  6. Knowledge of managed care concepts in relation to financial aspects of patient care
  7. Must be able to cope with the emotional and mental stress of the position and deadlines imposed on specific duties
  8. Excellent organizational skills with well-developed HRO skills and assertiveness
  9. Able to use critical thinking skills, problem solving abilities and an understanding of systems and change process
  10. Able to function autonomously, displaying personal integrity and always maintaining confidentiality
  11. Able to work with all levels of the multidisciplinary healthcare team
  12. Refined negotiating skills and the ability to deal with conflict resolution
  13. Demonstrates leadership skills and the ability to delegate tasks
  14. Functions in the role as patient/family advocate intervening as needs indicate
  15. Dresses in professional manner, wearing either lab coats or jackets when in the clinical setting

RESPONSIBILITIES AND EXPECTATIONS:

  1. Respects patients' rights and responsibilities
  2. Is courteous in dealing with all customers, whether external or internal
  3. Demonstrates compassion and sensitivity to all customers
  4. Shows respect for the customer's culture, language, customs, and beliefs
  5. Maintains high standard of ethical and professional behavior
  6. Actively participates in quality improvement activities within the department
  7. Utilizes available educational resources to maintain and develop knowledge and skills related to field of practice
  8. Actively oversees assignment of Observation status and manages status issues related to this service
  9. Demonstrates competency in Evidence-Based Guidelines (i.e. InterQual)
  10. Oversees patient's clinical progress to assure appropriate level of care, use of resources and timely care delivery
  11. Provides information so that external payer requirements are met to ensure reimbursement for the Hospital
  12. Identifies and participates in the development and implementation of strategies to reduce unnecessary resource consumption and length of stay on assigned patient population
  13. Monitors delays in care and discharge, actively intervening as appropriate to eliminate delays and provide timely access to care and services
  14. Collaborates with medical staff and other members of the healthcare team to ensure effective, efficient delivery of care and services
  15. Communicates, both verbal and written, post hospital care needs and plan to all members of the healthcare team
  16. Functions as resource to medical staff and Hospital staff regarding regulatory and payer requirements.
  17. Provides education and information to Clinical Vice Presidents and nursing personnel regarding patients in their areas of responsibility as needed
  18. Communicates concerns to other areas within the Hospital as appropriate (Performance Improvement, Infection Control, Risk Management)
  19. Works closely with Clinical Documentation Nurse to ensure information documented to meet the requirements of the third party payers
  20. Functions as team member, working closely with social workers, RN Case Manager, precertification/verification specialists to promote positive patient outcomes
  21. Identifies opportunities for inter and intradepartmental operational improvements
  22. Provides coverage for team members as needed

Additional information concerning physical requirements for the position:

Performing patient care responsibilities as required


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