Clinical Resource Manager Part-Time Days

About the role

The Clinical Resource Manager Baker City position at Saint Alphonsus Health System is part-time, working two days a week with Wednesdays required. Hours are from 7am-3pm, no weekends, no evenings, and no holidays. This role is based in a small, close-knit, supportive, critical access hospital.

Responsibilities

• Provides hospital case management/utilization review and discharge planning, collaborating with patients/families and physicians to ensure a smooth transition to the next level of care and services.
• Collaborates with social services to integrate into patient care as needed.
• Coordinates hospital activities related to 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.
• Supports physicians and other clinical members of the health care team in coordinating the delivery of services for a select group of patients.
• Incorporates real-time contacts with physicians, nursing, and ancillary care givers to establish specific treatment, cost, and transition targets and facilitate transition planning.

Requirements

• Current RN license in Oregon. Multistate licenses must establish residency with the Idaho Board of Nursing within 60 days from hire.
• BSN required. Master's degree preferred.
• A minimum of 2 years of varied hospital clinical experience is required. Experience in case management, home health, and/or the insurance industry is preferred.

Qualifications

• Knowledge and skills to competently care for all assigned age groups.
• Ensures 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.
• Conducts concurrent medical record review using established medical necessity criteria to determine correct level of care for acute patients.
• Maintains knowledge of federal, state, and private agency review requirements and regulations.
• 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, such as 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.
• Enhances a collaborative 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.

Skills

• Knowledge of federal, state, and private agency review requirements and regulations.
• Ability to communicate effectively with physicians, nurses, and other healthcare professionals.
• Strong organizational and problem-solving skills.
• Excellent interpersonal and customer service skills.
• Ability to manage multiple tasks and prioritize responsibilities.
• Proficiency in Microsoft Office Suite.

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.

Highlights and Benefits

Our commitment to diversity and inclusion is reflected in our hiring practices and workplace culture. We are committed to recruiting and retaining 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, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by federal, state, or local law. Our commitment is 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.