Riverside Health
Talent Acquisition Leader | Doctoral Candidate | Leadership Strategist | Connector of Research & Practice
Newport News, Virginia
Overview Works under the supervision of the Manager and the Director and is responsible for working in collaboration with the healthcare team to coordinate the care and service to patients across the continuum of care, promotes effective utilization and monitoring of healthcare resources and assumes a leadership role with the interdisciplinary team to achieve optimal quality, clinical and resource outcomes. Works under the direction of the leadership team to provide a comprehensive range of services or clinical care associated with and in accordance with standards of excellence established by Riverside Health system and facility goals and strategic plans.
What You Will Do
Demonstrates the ability to build trusting, collaborative relationships with staff, peers, physicians and other disciplines/ancillary services. In addition, capable of completing the problem solving cycle from identification to problem resolution so as to maximize opportunity or minimize problem. Demonstrates behaviors that reflect “commitment to my co-worker”.
Seeks to attain knowledge and competency that reflects current understanding of clinical practice, guidelines and measures promoting the mission, vision and values of RHS.
Collaborates with the physicians to ensure compliance with level of care assessments based on clinical needs and utilization criteria and issues relevant to noncoverage/possible denials.
Assesses patient records of population for identifying medical care gaps, ER utilization, acute hospital stays and readmissions. Performs utilization review activities in accordance with Riverside Regional Medical Center’s Utilization Management Plan. Confers regularly with physician on plan of care or continued stay and physician documentation.
Assesses patients and families to determine needs and available resources so that the needs of the individuals are met in the most cost effective way. Strives to continuously improve the quality, process and outcomes of patient care.
Oversees performance of appropriate and timely case management referral processing to include initiating and contacting payer’s case management office, contacting patients and monitoring consult status’ through closure of documentation in the payer database.
Qualifications Education
Program Graduate, Nursing (Required)
Bachelors Degree, Nursing (Preferred)
Experience
3-4 years Clinical experience (Required)
Previous Case Management specific experience (Preferred)
Licenses and Certifications
Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) Upon Hire(Required)
To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.
Seniority level Mid-Senior level
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
Virginia Beach, VA $25.00-$29.00 8 months ago
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Overview Works under the supervision of the Manager and the Director and is responsible for working in collaboration with the healthcare team to coordinate the care and service to patients across the continuum of care, promotes effective utilization and monitoring of healthcare resources and assumes a leadership role with the interdisciplinary team to achieve optimal quality, clinical and resource outcomes. Works under the direction of the leadership team to provide a comprehensive range of services or clinical care associated with and in accordance with standards of excellence established by Riverside Health system and facility goals and strategic plans.
What You Will Do
Demonstrates the ability to build trusting, collaborative relationships with staff, peers, physicians and other disciplines/ancillary services. In addition, capable of completing the problem solving cycle from identification to problem resolution so as to maximize opportunity or minimize problem. Demonstrates behaviors that reflect “commitment to my co-worker”.
Seeks to attain knowledge and competency that reflects current understanding of clinical practice, guidelines and measures promoting the mission, vision and values of RHS.
Collaborates with the physicians to ensure compliance with level of care assessments based on clinical needs and utilization criteria and issues relevant to noncoverage/possible denials.
Assesses patient records of population for identifying medical care gaps, ER utilization, acute hospital stays and readmissions. Performs utilization review activities in accordance with Riverside Regional Medical Center’s Utilization Management Plan. Confers regularly with physician on plan of care or continued stay and physician documentation.
Assesses patients and families to determine needs and available resources so that the needs of the individuals are met in the most cost effective way. Strives to continuously improve the quality, process and outcomes of patient care.
Oversees performance of appropriate and timely case management referral processing to include initiating and contacting payer’s case management office, contacting patients and monitoring consult status’ through closure of documentation in the payer database.
Qualifications Education
Program Graduate, Nursing (Required)
Bachelors Degree, Nursing (Preferred)
Experience
3-4 years Clinical experience (Required)
Previous Case Management specific experience (Preferred)
Licenses and Certifications
Registered Nurse (RN) - Virginia Department of Health Professions (VDHP) Upon Hire(Required)
To learn more about being a team member with Riverside Health System visit us at https://www.riversideonline.com/careers.
Seniority level Mid-Senior level
Employment type Full‑time
Job function Health Care Provider
Industries Hospitals and Health Care
Virginia Beach, VA $25.00-$29.00 8 months ago
We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.
#J-18808-Ljbffr