Nursing Jobs in Eaton, OH
$62,700 - $100,400 / hour
Job Summary: Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services. Essential Functions: Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care Engage with medical director when additional clinical expertise if needed Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management Provide guidance to non-clinical staff Provide guidance and support to LPN clinical staff as appropriate Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested Perform any other job related duties as requested. Education and Experience: Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years clinical experience required Med/surgical, emergency acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required MCG Certification or must be obtained within six (6) months of hire required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required Compensation Range: $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package. Compensation Type (hourly/salary): Hourly Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds. #LI-JM1 
$87,800 - $136,100 / year
We are recruiting for a motivated RN Care Coordinator, Care Management (Inpatient) to join our team! We are here for life’s journey. Where is your life journey taking you? Being the heartbeat of Denver means our heart reflects something bigger than ourselves, something that connects us all: Humanity in action, Triumph in hardship, Transformation in health. Department Hospital Care Mgmt Job Summary Under general supervision, the RN Hospital Care Coordinator is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary and patient/family collaboration to ensure quality and cost-effective outcomes are delivered within appropriate care coordination parameters. Coordination involves assessment, planning, support, and evaluation of patient care and related outcomes. Activities to be performed are screening for high risk and transition of care needs, interviews with patient/family, and progression of care facilitation with the healthcare team. The Care Coordinator is an active contributor in the development of systems (e.g., care maps, clinical paths) to improve the care of assigned patient populations and to move along the continuum. Essential Functions : Review Status and Level of Care Management • Ensures barriers are identified and escalated as needed. (35%) Clinical Care Screening and Resource Management • Upon referral conducts an initial clinical and psychosocial screen through review of the patient’s medical record, interview with the patient/family members and discussion with the physician and other healthcare team members. • Monitors the patient’s treatment plan, medical goals and prescribes services to facilitate provision of services/referrals that are needed to meet the needs of the patient during hospitalization thus driving the clinical care process. Coordinates any needed referrals, PT/OT, wound care, dietary, pharmacy, cardiac rehab, etc. to facilitate efficient patient flow through the hospital system. • Participates in Care Conferences and Care Rounds as required and assists with the development of care plans that will meet the patient’s current and continuing healthcare needs. • Ensures that services are appropriate for the patient’s level of care and identifies any test/procedure that could be done as an outpatient and discusses alternative with the physician. (35%) Risk Assessment and Transition of Care Screening • Identifies all readmissions within 30 days and initiates a readmission risk assessment within 24 hrs of identification. • Communicates the results of the risk and transition of care screening processes to the physician(s) and other healthcare team members, including external Case Managers and community-based clinic providers, as identified. • Generates a referral to the assigned Clinical Social Worker partner for implementation and collaboration of the transition of care plan throughout the hospital stay, as needed. • Supports the development and implementation of the patient’s transition of care plan working collaboratively with the Clinical Social Work partner. • Communicates any clinical changes that would alter the transition of care plan to all healthcare team members, especially the Clinical Social Worker. • Ensures state and federal regulations/rules and insurance company requirements/processes are met. • Documents the initial transition of care screening information in the patient’s clinical record according to departmental policies and procedures. (30%) Education : Associate's degree Completion of a nursing education program that satisfied the licensing requirements of the Colorado State Board of Nursing for Registered Nurses Required and Work Experience : 3 years of clinical inpatient experience Required Licenses : BLS-Basic Life Support (BLS/CPR) - AHA - American Heart Association Required RN-Registered Nurse - DORA - Department of Regulatory Agencies Required CCM-Certified Case Manager - ANSI - American National Standards Institute Preferred Knowledge, Skills and Abilities : Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment required. Effective problem-solving skills, including the ability to analyze complex situations, draw conclusions and implement actions appropriately and efficiently. Evidence of leadership, creativity, integrity and initiative required. Ability to work effectively in a team environment. Experience with windows-based computer programs and ability to use computer for data analysis and data display required; must be able to type 35 words/minute. EPIC experience a plus. Shift Days (United States of America) Work Type Regular Salary $87,800.00 - $136,100.00 / yr Benefits Outstanding benefits including up to 27 paid days off per year, immediate retirement plan employer contribution up to 9.5%, and generous medical plans Free RTD EcoPass (public transportation) On-site employee fitness center and wellness classes Childcare discount programs & exclusive perks on large brands, travel, and more Tuition reimbursement & assistance Education & development opportunities including career pathways and coaching Professional clinical advancement program & shared governance Public Service Loan Forgiveness (PSLF) eligible employer+ free student loan coaching and assistance navigating the PSLF program National Health Service Corps (NHCS) and Colorado Health Service Corps (CHSC) eligible employer Our Values Respect Belonging Accountability Transparency All job applicants for safety-sensitive positions must pass a pre-employment drug test, once a conditional offer of employment has been made. Denver Health is an integrated, high-quality academic health care system considered a model for the nation that includes a Level I Trauma Center, a 555-bed acute care medical center, Denver’s 911 emergency medical response system, 10 family health centers, 19 school-based health centers, Rocky Mountain Poison & Drug Safety, a Public Health Institute, an HMO and The Denver Health Foundation. As Colorado’s primary, and essential, safety-net institution, Denver Health is a mission-driven organization that has provided billions in uncompensated care for the uninsured. Denver Health is viewed as an Anchor Institution for the community, focusing on hiring and purchasing locally as applicable, serving as a pillar for community needs, and caring for more than 185,000 individuals and 67,000 children a year. Located near downtown Denver, Denver Health is just minutes away from many of the cultural and recreational activities Denver has to offer. Denver Health is an equal opportunity employer (EOE). We value the unique ideas, talents and contributions reflective of the needs of our community. Applicants will be considered until the position is filled. 
