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Clinical Services Specialist I / Part Time / Remote

Company: Tenet
Location: Saint Petersburg
Posted on: September 13, 2019

Job Description:

As a part of the Tenet and Catholic Health Initiatives family,Conifer Health brings 30 years of healthcare industry expertise to clients inmore than 135 local regions nationwide. We help our clients strengthen their financialand clinical performance, serve their communities and succeed at the businessof healthcare. Conifer Health helps organizations transition from volume tovalue-based care, enhance the consumer and patient healthcare experience andimprove quality, cost and access to healthcare. Are you ready to be part of oursolutions? Welcome to the company thatgives you the resources and incentives to redefine healthcare services, with acompetitive benefits package and leadership to take your career to the nextstep! JOB SUMMARY The Clinical Services Specialist is a member of themulti-disciplinary team that facilitates the patient's access to theappropriate level of care, health professional(s), and setting(s) to providecare and service(s) based on the patient's assessed needs and the hospital'scapacity to provide the care. It is theSpecialist?s responsibility to determine medical necessity. The individual in this position bears overallresponsibility for coordinating patient care activities to conform toevidence-based practice and/or regulatory/payor requirements. This position integrates functions typicallyconsidered to be case management, care coordination and/or utilizationmanagement, and discharge planning assessment. ESSENTIAL DUTIES ANDRESPONSIBILITIESInclude thefollowing. Others may be assigned.

  • Coordinating care (e.g., access, admission, discharge, aftercare) in conjunction with physicians, nurse and other clinical staff, payors, patients and their families.
  • Performing admission and continued stay review per policy and procedure.
  • Planning for discharge needs and arrangements, including leading multi-disciplinary discharge planning teams and assessing patients for discharge planning needs.
  • Reviewing utilization patterns.
  • Establishes and maintains effective working relationships with representatives of managed care plans.
  • Managing concurrent denials.
  • Coordinating weekly Complex Case Review.
  • Ensuring appropriateness of medical care provided and resources utilized compared to evidence-based practice and external requirements, including working with relevant systems and information such as InterQual, eCARE and ECIN.
  • Staying abreast of relevant advances in medicine.
  • Maintaining effective relationships with physicians, nurses and other clinical staff, payors, patients and their families.
  • Assisting with physician documentation.
  • Arranging for patient education.
  • Communicating and collaborating with physicians, their office staff and staff of ancillary departments (e.g., lab, pharmacy).
  • Maintaining accuracy of patient demographic and insurance information.
  • Making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST).
  • Complies with all policies & procedures that pertain to HIPAA including the minimum necessary requirements for this position.
  • As part of the requirements for this position, the employee has access to the entire medical record for the purpose of coordinating care and planning for discharge needs and arrangements.
  • Limits the protected health information (PHI) disclosed or requested to the amount reasonable necessary to achieve the purpose of the request. The disclosures or requests that occur on a routine basis include: patient demographics, condition, notification of actual/potential victim of abuse or neglect, description of injuries for the purposes of a crime investigation, actual/potential for organ donation & patient disposition updates.

    Qualifications:
    KNOWLEDGE, SKILLS,ABILITIESTo perform this jobsuccessfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill and/orability required. Reasonable accommodations may be made to enable individualswith disabilities to perform the essential functions.
  • Conversant knowledge and experience withcase management care coordination, and/or utilization review
  • Track record and comfort incollaborating with physicians
  • Ability to lead and coordinateactivities of a diverse group of people
  • Demonstrated ability in problem solvingand communications
  • Working knowledge of and basic skillswith computers EDUCATION /EXPERIENCEInclude minimumeducation, technical training, and/or experience required to perform the job.
    • Florida Registered Nurse license (R.N.)or Licensed Practical Nurse (L.P.N.) is required.
    • Emergency Nursing and Case Managementpreferred.
    • Three (3) years bedside experience inthe relevant clinical specialty (e.g., care managers for pediatric patientsshould have pediatric nursing experience) PHYSICAL DEMANDS The physical demandsdescribed here are representative of those that must be met by an employee tosuccessfully perform the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
    • Must be able to work in sitting position, use computer and answer telephone.
    • Required to use fine motor skills (typing/data entry), and reach with hands and arms.
    • Must be able to lift up to 25 lbs WORK ENVIRONMENT The work environmentcharacteristics described here are representative of those an employeeencounters while performing the essential functions of this job. Reasonableaccommodations may be made to enable individuals with disabilities to performthe essential functions.
    • Subject to varying and unpredictable situations, many interruptions, multiple calls and inquiries, and change.
    • May be required to work long hours and holidays. Job: Conifer Health SolutionsPrimary Location: Saint Petersburg, FloridaJob Type: PT1Shift Type: Days

Keywords: Tenet, St. Petersburg , Clinical Services Specialist I / Part Time / Remote, Healthcare , Saint Petersburg, Florida

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