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Patient Care Coordinator opportunity in San Jose, CA!

DEPARTMENT: Utilization Mgt.SCHEDULE: Part-Time Regular, 32 hours per week, Day shift. Monday through Thursday: 8:00am to5:00pm. Works every other Weekend, and the days, and hours will vary.EDUCATION: BSN or BA in health care related field or Diploma/Associate Degree Nursing (ADN) with comparable years of experience required. Masters Degree preferred.LICENSE/CERTIFICATION: Graduate of accredited school of nursing, BLS Certification, and current California RN licensure required.JOB SUMMARY: Performs utilization management activities, discharge planning, and care coordination across the continuum of care in collaboration with the physician and other members of the healthcare team.QUALIFICATIONS: Experience (usually 2+ years) in direct patient care delivery and management. Demonstrated experience in utilization review, case management, and discharge planning preferred (usually 2+years). Knowledge of the Nurse Practice Act, The Joint Commission, DMHC, CMS, NCQA, HIPPA, ERISA,EMTALA and all other applicable federal/state/local laws and regulations. Demonstrated strong communication and customer service skills, problem-solving, critical thinking, and clinical judgment abilities. Fundamental word processing and computer navigation skills and the ability to interpret and use analytic data in day to day operations. Knowledge of healthcare benefits associated with various business lines (Medicare/KPSA, Commercial/KFH, Medi-Cal, Federal, etc.).DUTIES:Utilization Management Performs daily preadmission, admission, and concurrent utilization reviews using guidelines, institutional policies/procedures, and other information to determine appropriate levels of care and readiness for discharge. Escalates utilization and system problems which have not been resolved at the local level to the next level (RM/UM Director, CCL, DHO, etc.), immediately. Monitors the progression of the plan of care and facilitates discussions with the multi-disciplinary teams. Educates other healthcare team members on utilization and cost containment initiatives. Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care. Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care).Discharge Planning Ensures continuity of care through communication in rounds and written documentation, level of care recommendations, transfer coordination, discharge planning and obtaining authorizations/approvals as needed for outside services for the patient. Develops, evaluates, and coordinates a comprehensive discharge plan in conjunction with the patient/family, physician, nursing, social services, and other healthcare providers and agencies. Performance Improvement Monitors care processes to provide cost-effective implementation and evaluation of utilization management and patient care activities, initiatives, and protocols. Participates in the development and implementation of guidelines, preprinted physician orders, care paths, etc. for patient care .Identifies and assists in the implementation of opportunities for cost-savings and improvements in the quality of care across the continuum. Develops, collects, trends, and analyzes data relevant to the utilization of healthcare resources including avoidable/variance days, readmissions, one-day stays, DRGs, LOS, etc. Participates in the development, implementation, communication, maintenance and monitoring of local UM Work plan initiatives. Administrative and Regulatory Shares accountability with the UM Manager for planning, developing, and managing the department budget. Participates in interviewing, makes hiring recommendations, orients and provides on-going supervision of support staff. Provides input into the performance evaluations of team members. May plan and control work assignments and special projects of team members Assists in developing, implementing and maintaining utilization management policies and procedures. Conducts UM, care coordination, and discharge planning activities according to all applicable regulatory requirements (see qualifications).Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Consistently supports compliance and the Principles of Responsibility (KP’s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer -

Focused on the future.Ours & Yours.Weiss Memorial Hospital, located along Chicagos lakefront, is focused on the future of our organization as well as the future of your career! Join our growing organization and see the difference it will make in your career.Quality AnalystYou will support quality process improvement projects by performing data abstraction, analysis and entry, data base development and report generation. Your responsibilities will include accurate database entry, collection, abstraction, analysis, interpreting and reporting quality data for Weiss Memorial Hospital executive staff, medical staff and appropriate teams and committees.Requires a Bachelors degree and current RNs license for the state of IL. You must have three or more years experience in Cardiology. Experience in data abstraction and interpretation, data entry, data analysis, creation of spreadsheets and displaying statistical information on outcome measures preferred. Excellent organizational skills will be necessary, as well as the ability to prioritize projects based on need and deadlines. CPR and ACLS required.

Nemours is currently seeking a Performance Improvement and Patient Safety Coordinator for Joint Commission Accreditation and Environmental Safety located at our Alfred I. duPont Hospital for Children in Wilmington, DE.

This position is responsible for the coordination of the Joint Commission accreditation preparedness activities throughout the Delaware Valley and for ensuring the continuous readiness for announced and unannounced surveys of the hospital and affiliated organizations including offsite facilities. Responsibilities include meeting and demonstrating compliance to regulatory/accreditation requirements. This role will also coordinate development and implementation of programs designed to ensure employee, patient, and visitor safety and agency compliance with Environmental safety, health and environmental regulations for specified facilities and operations.Key Responsibilities:*Assists in the identification of specific organizational needs and priorities related to accreditation and safety *Collaborates with key stakeholders to develop long-range goals, objectives, and strategies for accreditation survey readiness and environmental safety *Establishes a process, in collaboration with Departmental Leaders, for proactively assessing the Hospital and/or Practice for Joint Commission accreditation survey readiness.*Establishes a process, in collaboration with Departmental Leaders, for proactively assessing the Hospital and/or Practice for Environmental safety, including Life Safety, improvement opportunities.*Utilizes appropriate assessment tools and techniques to assess compliance with Joint Commission Accreditation and Environmental Safety Standards*Analyzes data to identify trends and opportunities for improvement as assigned. Educates and acts as a resource to all hospital and practice personnel on standards related to Joint Commission accreditation and Environmental safety.*Be experienced in both successful accreditation preparation as well as environmental safety management. *Be able to relate to all levels within the organization in order to both assess their knowledge and compliance with the regulations as well as educate them when deficits are identified. *Be able to methodically assess the level of compliance with various accreditation and safety standards and then analyze the gaps in order to formulate an effective plan of correction.JOB REQUIREMENTS: *Successful candidate must be a RN or Certified Professional in Healthcare Quality (CPHQ). Must have Bachelor´s degree in health related field (Master’s preferred). Minimum of five (5) years experience in healthcare management and organization -wide accreditation activities. Minimum three (3) years experience with organization-wide environmental safety activities.At Nemours, we´re dedicated to achieving higher standards in children´s health. And we begin by caring for children as if they were our own. For more than 70 years, this has been the Nemours Way. Thank you for your interest.

DEPARTMENT:Skilled NursingSCHEDULE:Part-Time regular, 20 hours per week, Vary shift, Monday, Friday - 8:30am - 5:00pm &Wednesday - 8:00am - 12:30pm w / weekend rotation.EDUCATION/LICENSE/CERTIFICATION:BSN or BA in health care related field preferred. Graduate of accredited school of nursing. Current California RN license. PHN preferred. JOB SUMMARY:Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process.QUALIFICATIONS:Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes.PREFERRED QUALIFICATIONS:Previous experience in an inpatient setting (usually 2 years). Previous experience utilization experience required (usually 1 year). Clinical expert in area of review preferred. Demonstrated knowledge of diagnostic codes. Provide clinical oversight for determination of medical necessity for admission to SNF & clinical denials based on medical necessity. Cross train to provide coverage for dept. manager. Cross train for SNF case manager which responsibilities include daily case management of patients while they are in the SNF, working with Kaiser team and contracted SNF team to coordinate needed care, discharge plans, equipment, education, follow-up medical appointments and family interaction and participation in plan of care.Cross train to SNF placement desk working with hospital discharge planners to find an appropriate SNF, secure bed and coordinate patient transfer with discharge planner. This consists of screening referrals for skilled determination, collecting needed documents for placement, coordinate obtaining bed with the SNF vendors and discharge planners, reports on PD placements. Additional responsibilities: create bi-weekly work schedule, reconciliation of Avoidable Days, utilization management reports & appeals processSKILLS TESTING: DUTIES:Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other healthcare providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and health care plan coverage. Coordinates referrals to appropriate agencies/facilities. OTHER DUTIES:Conducts utilization review for in-house patients and those members at contracted facilities. Assists in the discharge planning process. Conducts utilization review for in-house patients as well as those members who have admitted to contracted facilities. Conducts clinical reviews based on established treatment criteria. Reviews utilization patterns, identifies trends and problems areas for special studies. Assists other health care providers in the discharge planning process and triaging on alternative unit of care. Assists in collecting and assimilating clinical data to enhance the quality of services. Generates quality improvement results. Collaborates with physicians on clinical reviews, keeps them appraised of Kaiser clinical criteria. Reports and investigates unusual occurrences and questions inappropriate decisions based on their professional expertise. Interviews patients/caregivers regarding care after hospitalization. Counsels on Medicare and healthcare plan coverage. Coordinates referrals to appropriate agencies/facilities. Must have experience in skilled nursing facility nursing as well as an understanding of Medicare guidelines for skilled nursing facilities and skilled coverage for care.Case management experience strongly recommended..Kaiser Permanente conducts compensation reviews of positions on a routine basis. At any time, Kaiser Permanente reserves the right to reevaluate and change job descriptions, or to change such positions from salaried to hourly pay status. Such changes are generally implemented only after notice is given to affected employees. Consistently supports compliance and the Principles of Responsibility (KP�s code of conduct) by maintaining confidentiality, protecting the assets of the organization, acting with ethics and integrity, reporting non-compliance, and adhering to applicable Federal and State laws and regulations, accreditation and licensure requirements, and KP policies and procedures. In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives. Also accountable for consistently demonstrating the knowledge, skills, abilities, and behaviors necessary to provide superior and culturally sensitive service to each other, to our members, and to purchasers, contracted providers and vendors.PLEASE NOTE: - Kaiser Permanente is an AA/EEO employer

Johns Hopkins Bayview Medical Center

Open the door to the best of both worlds-Johns Hopkins Bayview Medical Center offers a unique environment that combines the prestige and opportunities of a respected academic medical center with the personality and camaraderie of a community hospital.We currently have an opening for a Quality Information Analyst.Responsibilities:- Navigating a number of electronic systems including Care Science, MHA Core Measures, Datamart, Meditech and other clinical information systems- Using statistical and analytical skills to maintain or enhance quality data information systems and resolving problems requiring a comprehensive and state-of-the art awareness of the technology- Communicating effectively in order to participate in hospital wide projects and individuals within the organization to identify and meet quality data needsRequirements:- Associates Degree, BSN preferred - Current Maryland licensure as Registered Nurse - Knowledge of theories, principles, and concepts typically acquired through completion of a degree in clinical informatics or at least 1 year of experience with clinical information systemsWe´ve listened to our nurses and understand the importance of providing excellent benefits that top what others in the industry can offer. We offer health, dental, and vision benefits, as well as tuition reimbursement for you and your dependents.

GENERAL SUMMARY: Under general supervision of the Director of Quality, is responsible for facilitating continuous improvement activities using the Lean methodology PRINCIPAL DUTIES AND RESPONSIBILITIES:Coach and support teams and individuals on properly identifying the 7 wastesTeach and train teams and individuals on the application of problem specific tools to support the Kaizen Activity Facilitate the deployment of capable and successful Kaizen teams for the purpose of elimination of waste As applicable coordinate the documentation of Kaizen/experiment using standard Lean tools Insure proper implementation and continued follow-up until Kaizen/experiment is hardwired Conduct regular observations of completed Kaizen/experiments to support and coach Provide input and recommendations for further continuous improvement activities to area managers Support the development and implementation of organizational wide Lean learning. Establish and grow relationships with those closest to the work KNOWLEDGE, EXPERIENCE, AND OTHER JOB REQUIREMENTS:The level of knowledge equivalent to that is normally acquired through completion of a Bachelors DegreeStrong leadership, coaching and teaching abilities Five years of related experience, including first hand experience leading and conducting Kaizen events preferably in a health care environmentCandidate must be able to demonstrate first hand knowledge and proper use of Lean as a business strategy Strong analytical, organizational and problem solving skillsExceptional communication (primarily verbal and listening) skills with ability to interact effectively with all levels throughout the organization. Knowledge of personal computer applications (Excel, word, etc.) WORKING CONDITIONS: Normal sedentary office environment. Work requires frequent mental/visual effort in reviewing documents The above statements are intended to describe the general nature and level of the work being performed by people assigned this job. They are not exhaustive lists of all duties, responsibilities, knowledge, skills, and abilities associated with the job.

Vibrant, growing organization with opportunities to suit your professional skills and a diverse work environment.

Who Cares? We Do!. . . for our patients, our communities, and each other Allina Hospitals & Clinics!Located in Minnesota and western Wisconsin, we are a not-for-profit system of hospitals, clinics and other health care services, united in caring for our patients with unparalleled talent, knowledge and technology; caring for our communities through collaborative efforts to promote stewardship, compassion and wellness; and caring for each other in an environment that puts patients first and helps passionate people excel. This is what makes Allina unique. Won´t you join us?Allina Commons is the Minneapolis-based headquarters of Allina Hospitals & Clinics, a not-for-profit health care organization serving patients and communities. Approximately 1,600 corporate and administrative service employees work at offices within Midtown Exchange, site of the historic Sears retail complex at Chicago Avenue and E. Lake Street. This community landmark, adjacent to the campus of Allina´s Abbott Northwestern Hospital, is the second largest building in Minnesota and includes offices, an internationally themed public market and residential units.Responsibilities:Assess inpatient and observation admission according to admission criteria for all different hospital disciplines (Mental Health, Substance Abuse, Acute Care, Rehab, Observation, etc.) Assess clinical data from medical records to assure appropriateness of patient´s admission. Ensure proper authorization requirements are met with each admission. Monitor continued stay, identify potential issues, and communicate the results and opportunities to nurses, physicians, finance, case managers, and payers. Provide consultation to medical and nursing staff, health information management, payers, patients, and patients on potential issues with reimbursement of hospitalization. Evaluate potential denials or payment issues and initiate communication with physician and / or clinician to assure proper documentation for selected admission status. Assure proper physician order is in the record for the correct patient status. If the order is incorrect, facilitate discussion with the appropriate physician. Refers case to a review physician when the treatment request does not meet necessarily per guidelines, when guidelines are not available, or per customer account instructions. Referrals must be made in a timely manner, allowing the review physician time to make appropriate contact with the attending provider.Qualifications:RN - BSN preferred. 3-5 years of acute care experience preferred. Understanding/ knowledge of Interqual and Milliman and Roberson Admission criteria, preferred. Knowledge of medicare, medicaid, and other third party payer admission requirement. Knowledge of managed care concepts including utilization management, prior authorizations, and denial and appeal process.Pay, Benefits & Work Schedule:***Temporary position*** 32 hours per week Day and Evening shifts Every other weekendWe have a place for you at Allina Hospitals & Clinics. If you are interested in becoming part of our award winning team of professionals, please apply online today at www.allina.com/jobs and reference job opening id 416930. Allina is proud to offer highly competitive salaries and comprehensive benefits that include a 401(k)/403(b), tuition reimbursement, day care reimbursement accounts, banking services and much, much more. Check online for other opportunities throughout Allina!

Specializing in you...serving San Diegos inland North County communities for more than 50 years, PPH is a family of outstanding healthcare facilities that cover an area of more than 800-square miles. As the largest hospital district in Southern California, we are also one of the most diverse. From our state-of-the-art Cardiac Care and Rehabilitation Facilities and busy Trauma Center to Home Healthcare, we deliver a full spectrum of health services to meet the needs of every member in our community.We have an excellent opportunity for a Full-Time Defense Audit Denials RN who will be responsible for the clinical review of all charges on patient encounters in five primary areas of focus: 1) payer defense audits 2) pre-billing chart to charge reviews on high risk patient encounters for compliance and /or lost revenue 3) post billing chart to charge reviews as areas of risk are identified 4) clinical denials to mitigate the loss of revenue 5) refund requests to review for missing chargesResponsibilities include:Summarize reviews into clear and concise reports for management review.Reports to include recommendations for corrective action, which can include staff training and process improvement; creates and maintains database of reviews performed and reports trends to management at least monthly; serves as a resource to clinical areas to identify lost charge improvement opportunities.Possess analytical ability to design methods, collect and review data, formulate appropriate solutions and compile reports. This individual prioritizes work based on findings and risk; performs multiple tasks and modifies review approaches based on the organizations changing situations and needs, and follows through to achieve final resolution. Ability to effectively communicate, both written and verbal, with all levels of the organization. Work independently and as a cohesive team member seeking opportunities throughout PPH to improve effectiveness in charge capture and increased accuracy of clinical documentation. Responsible for coordinating and managing appeals for clinical denial of payment by medical record review with input from the physician advisor, attending physician, nurse case managers, and UR nurses. Serves as a liaison between patient financial services (PFS). Provides Case Management (CM)and Utilization Review (UR) for appeal-denial related issues. Generates formal letters of appeal to the insurance carrier. Responsible for collecting and maintaining data relating to appeals and outcomes.Explores opportunities for improvement in an effort to increase hospital reimbursement and decrease the rate of clinical denials.Maintains ongoing education and working knowledge of insurance regulations and claims audit. Maintains data spreadsheets with ability to prepare and present reports as requested. Maintains and utilizes excellent interpersonal, verbal and written skills effectively with ability to work independently to prioritize workload to meet appeal deadlines. Performs other duties as assigned. Follows PPH rules, policies, procedures, applicable laws, and standards.Carries out the mission, vision, values, and quality commitment of PPH.We promote a philosophy that encourages growth and satisfaction. We provide a work environment that is open and empowering, where you can experience a wide range of clinical, educational, and management opportunities. We also support a healthy balance between your personal and professional lives. We are located in an area that is enriched with a sense of belonging, where everyone pulls together in a common philosophy of life. Its an area that affords all who live here the luxury to pursue any interest or lifestyle they choose.RequirementsMinimum Education: As required by certification and/or licensurePreferred Education: Bachelors Degree in NursingMinimum Experience: 2 years hospital denials management, 4 years experience in an acute care facility and/or health care consulting; and Quality Assurance/Utilization ReviewPreferred Experience: 4 years hospital denials management, 5 years experience in an acute care facility and/or health care consulting; Quality Assurance/Utilization ReviewRequired License: Current CA RN License and Valid Drivers LicenseWe invite you to join us in our Mission to Heal, Comfort, and Promote Health in the Communities We Serve!

Become a Cedars-Sinai Employee!

Hours: 8am - 4:30pm Days: Monday - FridayShift Type: DayWeekends: None Job Description: Cedars-Sinai Health System has an opening for a RN, Supervisor Case Review. The Case Review Supervisor will be responsible for the day to day oversight of the Peer Review Process. The supervisor will review correspondence and assist case review coordinators with routine process questions. The Supervisor must demonstrate initiative, resourcefulness and problem-solving skills in applying a detailed knowledge of the responsibilities, functions and underlying management structure of the department and of the larger Health System in organizing and prioritizing work, establishing procedures and systems and ensuring the orderly and timely flow of business. The Supervisor must possess a full understanding of the confidentiality requirements to effectively and legally communicate practitioner related issues. The supervisor will communicate to the Patient Safety Manager all concerns and issues of a non routine nature or potential safety issue. In addition, the supervisor will be responsible for coordinating the Ongoing Professional Practice Evaluation (OPPE) for the medical staff. The Supervisor will have oversight of the Case Review Coordinator who will focus on identifying professional practice trends that impact quality of care and patient safety. The Supervisor will utilize expert clinical knowledge and experience to collaborate with the Case Review Coordinator using the Medical Center and Department specific criteria. Education and Work Experience Preferences: Educational Requirements:Bachelors Degree preferred and course work in healthcare related field preferred.License/Certification/Registration Requirements:Current active licensure as Registered Nurse in California required; Certified Professional in Healthcare Quality preferred

The Director, Post Acute QA PI/Education is directly responsible to lead, develop and implement effective methods to: assess and ensure quality assurance/process improvement initiatives; oversee clinical staff orientation, education and competency assessments; monitor and assure compliance with regulatory standards; interface with IT staff for effective design and use of electronic medical record and billing software; and oversee effective case management practices for Summa´s Home Care, Hospice of Summa, Summa´s Maternal Touch and Summa´s Home Infusion.The Director, Post Acute QA PI/Education serves as a resource to Summa Health System merged and/or affiliate hospitals post acute programs in sharing, developing and implementing: quality assurance/process improvement methods and practices; staff orientation, education and competency plans and presentations; regulatory compliance standards and updates.Requires a Masters degree in Nursing, Business, Hospital Administration, or other related field of study and a current license to practice nursing in the State of Ohio.Three (3) years QI/Education experience in a homecare/hospice environment to include two (2) years of leadership experience required.