Providence
Care Manager RN @ Swedish Medical Center
Full time 1 FTE Day shift Fantastic benefits and compensation package offered by Providence that begin on your first day of employment. Join us, and find out how many ways we offer you the chance to focus on what really matters - our patients. Responsibilities
Collaborates and consults with appropriate departments and providers as needed to determine that medical necessity indicators are met. Provides a clinical review of the medical record to determine an admission status type of a patient. Conducts concurrent clinical reviews to assess ongoing medical necessity. Identifies, reports cases and problems appropriate for secondary review to Case Management leadership, the Medical Director or Physician Advisor. Facilitates appropriate provider documentation to accurately reflect patient severity of illness and risk. Maintains collaborative relationships with providers, case management staff, clinics, Revenue Cycle team, and Payer Compliance team. Responsible for submitting clinicals, entering authorizations of both concurrent and hospital stays after discharge. Conducts appeals as applicable. Collaborates with providers, compliance, contracting, revenue cycle, internal and external Physician Advisors. In addition, works with other departments as needed for medical necessity matters. Works in accordance with applicable state and federal laws as well as with the unique requirements of reimbursement systems. Facilitates accurate, compliant clinical documentation by providing concurrent support to providers to optimize reimbursement. Stays current in UR to be informed of reimbursement modalities, resources as well as clinical and legal issues that affect patients and providers of care. Provides leadership with needed workflow reports to analyze productivity, quality concerns, utilization patterns, and denial patterns/trends. Participates in the development, implementation, evaluation, and ongoing revision of initiatives to improve quality, continuity, and cost-effectiveness. Provides clear and thorough documentation based on established department standards. Coordinates education and training for staff and other health care providers regarding utilization management process, including but not limited to: reimbursement patterns, trends, changes in regulations, and strategies. Provides orientation and mentoring to new staff. Escalate issues to Case Management team or leadership in a timely manner. Required Qualifications
Bachelor's Degree Nursing degree (BSN) from an accredited school of nursing. Upon hire: Washington Registered Nurse License 3 years Registered nursing experience in the clinical setting. Preferred Qualifications
Upon hire: ACM or CCM certification 1 year Case management experience. Why Join Providence
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve. Equal Opportunity Employer
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Location
WA Seattle 1730 Minor Ave (workplace type: On-site)
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Full time 1 FTE Day shift Fantastic benefits and compensation package offered by Providence that begin on your first day of employment. Join us, and find out how many ways we offer you the chance to focus on what really matters - our patients. Responsibilities
Collaborates and consults with appropriate departments and providers as needed to determine that medical necessity indicators are met. Provides a clinical review of the medical record to determine an admission status type of a patient. Conducts concurrent clinical reviews to assess ongoing medical necessity. Identifies, reports cases and problems appropriate for secondary review to Case Management leadership, the Medical Director or Physician Advisor. Facilitates appropriate provider documentation to accurately reflect patient severity of illness and risk. Maintains collaborative relationships with providers, case management staff, clinics, Revenue Cycle team, and Payer Compliance team. Responsible for submitting clinicals, entering authorizations of both concurrent and hospital stays after discharge. Conducts appeals as applicable. Collaborates with providers, compliance, contracting, revenue cycle, internal and external Physician Advisors. In addition, works with other departments as needed for medical necessity matters. Works in accordance with applicable state and federal laws as well as with the unique requirements of reimbursement systems. Facilitates accurate, compliant clinical documentation by providing concurrent support to providers to optimize reimbursement. Stays current in UR to be informed of reimbursement modalities, resources as well as clinical and legal issues that affect patients and providers of care. Provides leadership with needed workflow reports to analyze productivity, quality concerns, utilization patterns, and denial patterns/trends. Participates in the development, implementation, evaluation, and ongoing revision of initiatives to improve quality, continuity, and cost-effectiveness. Provides clear and thorough documentation based on established department standards. Coordinates education and training for staff and other health care providers regarding utilization management process, including but not limited to: reimbursement patterns, trends, changes in regulations, and strategies. Provides orientation and mentoring to new staff. Escalate issues to Case Management team or leadership in a timely manner. Required Qualifications
Bachelor's Degree Nursing degree (BSN) from an accredited school of nursing. Upon hire: Washington Registered Nurse License 3 years Registered nursing experience in the clinical setting. Preferred Qualifications
Upon hire: ACM or CCM certification 1 year Case management experience. Why Join Providence
Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally, and achieving financial security. We take care of you, so you can focus on delivering our mission of improving the health and wellbeing of each patient we serve. Equal Opportunity Employer
Providence is proud to be an Equal Opportunity Employer. We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law. We believe diversity makes us stronger, so we are dedicated to shaping an inclusive workforce, learning from each other, and creating equal opportunities for advancement. Location
WA Seattle 1730 Minor Ave (workplace type: On-site)
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