Clinical Services Specialist I / Part Time / Remote
Location: Saint Petersburg
Posted on: September 13, 2019
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
- 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
- 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,
- Maintaining accuracy of patient demographic and insurance
- Making the appropriate referrals to other departments (e.g.,
- Complies with all policies & procedures that pertain to HIPAA
including the minimum necessary requirements for this
- 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
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
- 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
- Must be able to work in sitting position, use computer and
- 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
- 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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