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Advocate Health Care is currently seeking candidates for a Quality Improvement- QI position.

This position is responsible for enhancing patient care and satisfaction through quality activity, monitoring and to coordinate and execute the specific tasks required for efficient and effective operation of the quality improvement program in accordance with department, contractual and regulatory agency standards.Qualifications: Good organizational and interpersonal skills.Computer skills, basic keyboard knowledge. Willingness to be flexible with work scheduleKnowledge of managed care or utilization review or hospital quality. BSN or 2-4 equivalent years experience in managed care.1-2 years experience in utilization management/QI activity. 3-5 years of clinical experienceCurrent RN license issued by the state of IllinoisCurrent CPR certificationAdvocate Health Care, based in Oak Brook, Illinois, is the largest fully integrated health care delivery system in metropolitan Chicago and the state of Illinois, and is recognized as one of the top health care systems in the country. Advocate is the second largest private sector employer in metropolitan Chicago with more than 25,000 associates and has the largest trauma network in the state of Illinois.

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

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!

Qualifications: Current California RN license. BSN or BA or BS degree in healthcare related field such as management, health services administration. At least three (3) to five (5) years experience in utilization management and discharge planning in an acute care setting to also include previous supervisory or management experience. Demonstrated knowledge of operations and healthcare management; JCAHO, Title XXII, Medicare, MediCal and other local, state and federal regulations. Knowledge of managed care operations. Demonstrated interpersonal, negotiation, and management skills. Good oral and written communication skills.Duties: Assists in developing and maintaining policies and procedures for the Service Area or Medical Center related to Utilization Management. Collaborates with the multi disciplinary team´s to plan and coordinate care across the continuum. Coordinates and manages members´ care with non KFH hospital facilities and providers. Identifies risk management and quality of care issues across the continuum. Surfaces issues and any suggestions to the appropriate multi disciplinary team members. Manages transportation program to ensure appropriate utilization of resources which meet Health Plan guidelines and patient needs. Assures compliance with Federal, State, JCAHO, NCQA, other regulatory agencies and internal standards and requirements.Provides direction to staff regarding utilization review, care coordination, discharge planning, and other services across the continuum of care. Assists in conducting statistical studies in utilization trends, patterns, and outcomes. Hires, trains coaches, disciplines professional and clerical support staff. Consistently supports compliance and the Principles of Responsibility (Kaiser Permanente´s Code of Conduct) by maintaining the privacy and confidentiality of information, protecting the assets of the organization, acting with ethics and integrity, reporting non compliance, and adhering to applicable federal, state and local laws and regulations, accreditation and licenser requirements (if applicable), and Kaiser Permanente´s 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.Kaiser Permanente is an EEO/AA Employer.Notes: Schedule varies.