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The Assistant Case Management provides support for the Clinical Services Department, including Outpatient Case Managers, Social Services team, and Health Education, specifically through the coordination of services within the DHMSO Clinical Programs and DHMSO Case Management program.   - Serves as an intake coordinator for referrals into disease management program(s), coordinating requests for services, monitoring members, and reporting findings. The Assistant Case Management is responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff. - Maintain accurate records of referrals, appointments, evaluation and management process for the Clinic and Case Management program. Processes referral requests according to company policy - Functions as a resource for access into Cerner for Comprehensive Care and Case Management teams. - Confirms medications currently taken by member during each call. - May communicate obtained information to PCP, Home Visit Program MD or DHMSO Clinical Programs MD as directed. - Knowledge and understanding of IPAs, PPOs, and HMOs with regard to benefits, policies and procedures, documentation requirements and medical terminology. 
Job ID
2021-167421
Department
Care Coordination
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Assistant Case Management provides support for the Clinical Services Department, including Outpatient Case Managers, Social Services team, and Health Education, specifically through the coordination of services within the DHMSO Clinical Programs and DHMSO Case Management program.   - Serves as an intake coordinator for referrals into disease management program(s), coordinating requests for services, monitoring members, and reporting findings. The Assistant Case Management is responsible for gathering clinical information from outside sources such as PCPs, specialists and other providers, hospital logs, Cerner, PCM, hospital case managers, and outpatient UM staff. - Maintain accurate records of referrals, appointments, evaluation and management process for the Clinic and Case Management program. Processes referral requests according to company policy - Functions as a resource for access into Cerner for Comprehensive Care and Case Management teams. - Confirms medications currently taken by member during each call. - May communicate obtained information to PCP, Home Visit Program MD or DHMSO Clinical Programs MD as directed. - Knowledge and understanding of IPAs, PPOs, and HMOs with regard to benefits, policies and procedures, documentation requirements and medical terminology. 
Job ID
2021-164674
Department
Care Coordination
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Redlands
Conducts medical reviews for necessity, level of care, and benefit reviews rendered in the inpatient and outpatient setting to ensure the patient receives the highest level of care.  Coordinates with providers, provider staff, and hospital staff, patients and patient family members to establish an appropriate level of care.   JOB KNOWLEDGE, SKILLS & ABILITIES - Knowledge of nursing processes, care management, and continuity of care. - Familiarity with regulatory requirements for managed care, HMOs, and EPOs. - Ability to apply criteria to identify appropriate level of care on all admissions and clearly document any research conducted and rationale of decisions made.  Ability to identify care needs across the age continuum and according to principles of growth and development over the life span. - Ability to apply appropriate business rules, medical guidelines and/or health plan benefits to authorization decision making. - Proficiency with health plan criteria/benefits and regulatory requirements as they relate to patient management across the continuum of care. - Proficient with standardized criteria, Interqual/Milliman, MCG, Medicare, etc. - Knowledge of network and benefit limitations and ability to collaborate with stakeholders to find alternatives that meet patient needs and achieve positive outcomes. - Knowledge of disease management strategies. - Basic knowledge of CPT and ICD 9/ICD 10 codes. - Ability to interpret and communicate complex contract or benefit language. - Willingness to work as part of a team, working collaboratively with others to achieve goals, solve problems, and meet established organizational objectives and management of patients.
Job ID
2021-166026
Department
Utilization Review
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
  Job Summary:  The Clinical Research Associate (CRA) position, is an office based position located at Barrow Neurological Institute, on the St. Joseph’s Hospital and Medical Center Campus. This position will report directly to the BNI Clinical Research Organization (CRO) Program Manager. The CRA position will independently be responsible for clinical monitoring activities and overall project administration to oversee the progress of multi-center, investigator initiated, or industry sponsored clinical studies throughout the United States and Canada.  The CRA will travel to assigned clinical research sties to conduct approx. 25-30 clinical trial monitoring visits each year, and will also complete remote/centralized monitoring visits to ensure clinical studies are conducted, recorded, and reported in accordance with the protocol, standard operating procedures (SOPs), International Conference on Harmonization- Good Clinical Practice (ICH-GCP) guidelines, and all applicable regulatory requirements. The CRA will be responsible for the timely reporting of all monitoring visit findings, and is expected to complete comprehensive monitoring reports and associated deliverables to provide back to the Sponsor and the clinical sites. Additionally, the CRA role will oversee clinical site training activities and, conduct remote webinar and onsite protocol trainings for Physician Site Investigators, Clinical Research Coordinators, Research Nurses, and other delegated healthcare study personnel. The CRA will be responsible for managing all monitoring visit travel arrangements and travel expense reporting activities in accordance with Dignity Health’s travel purchasing policy. The CRA role will actively participate in departmental quality control and program development activities as directed by the BNI CRO Program Manager   Located in Phoenix, AZ, this position is critical to the success of St. Joseph's Hospital Medical Center and requires the full understanding and active participation in fulfilling the Mission of Dignity Health.    
Job ID
2021-160206
Department
Research - Cro Activities
Facility
St Josephs Hospital and Medical Center
Shift
Day
Employment Type
Full Time
Location
AZ-PHOENIX
Responsible for all credentialing activities associated with all IPAs and product lines managed by DHMSO. Works with Credentialing Supervisor, Medical Directors, Provider Relations Department, Contracting Department, health plans, providers, provider office staff, and other persons or businesses as necessary to ensure that all providers are properly credentialed according to NCQA and health plan standards. Where appropriate, makes recommendations regarding improvement of processes and procedures.
Job ID
2021-163264
Department
Credentialing
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Redlands
The Director of Provider Network Relations is a business-minded leader who is able to cultivate, build and maintain relationships with health care providers, provide thought leadership and innovation and support sustained growth. Provides strategic direction and tactical leadership to ensure provider experience, will provide direction as it relates to communication and interactions with providers. This will include direct oversight of the Provider Network Relations department, which includes the management, and mentoring of the Provider Relations representative team, oversight of provider relations as a whole for DHMSO, which includes network education, front line provider communication, issue resolution and expansion of networks. The Director will have a collaborative relationship with the clinical executive leader(s) and ensure there is a consistent partnership to design, drive and execute on the provider relations approach/vision. Provide consistent communication to executive leadership to improve our business model with providers, which will encourage the improvement of health for our patients.     #missioncritical   "provider relations" manager
Job ID
2021-166792
Department
Member Services
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
Job Summary   *Depending on qualifications a candidate may be hired on as an End User Technician I, II, III, or IV.   End User Technician I   Provides desktop hardware setup and basic support for the user community. Works on one or more functional applications and performs work that tends to be entry level technological and business function complexity. Responsible for desktop hardware support to the user community for functional area(s) and ensures reliability of the devices   End User Technician II   The End User Technician II provides desktop hardware support for the user community. Works on multiple functional systems that tend to be of moderate to high complexity. Responsible for desktop hardware support to the user community for functional area(s) and ensure reliability of the devices.   End User Technician III   Provides the desktop hardware deployment and implementation of low to medium complexity and cross functional programs or projects and/or provides support for the user community with high complexity. Responsible for working with customers in the support, maintenance and deployment of desktop hardware as well as the information support processes.   End User Technician IV   The End User Technician IV provides desktop hardware support expertise and direction in the implementation of highly complex / enterprise wide cross functional programs or projects. May lead team to resolution of highly complex problems.   Responsibilities . End User Technician I - Responds to incidents, executes diagnosis, and performs incident resolution for those requiring low to moderate complexity; utilizes knowledge management. Escalates issues when necessary. - Responds to customer requests via the Service Management application. Fulfills request of low to moderate complexity utilizing repeatable documented procedures. Interacts with the customers in a courteous and professional manner. - May handle facility logistics including hardware receiving and maintenance of equipment depot. Enters appropriate data into the device asset management system and the knowledge management system. - Receives necessary information or training to perform basic troubleshooting, installation, upgrades and fixes for new and current devices. Participates in on-call rotation and provides on-call support. - May perform data operations functions, data entry, backup tape changes or other responsibilities as necessary to ensure the successful day-to-day operations. - Maintains awareness of and adheres to Operational Level Agreements (OLAs). - Interacts daily with the user community as it relates to Incident Management and Request fulfillment. - Maintains understanding and adherence to policies and procedures and may provide input to creation or modification of policies. End User Technician II - Provides desktop hardware support for the user community. Works on multiple functional systems that tend to be of moderate to high complexity. - Performs troubleshooting for moderate to high complex hardware, software and system problems. Acts as subject matter expert for at least one device type. - May be assigned to one or more projects as a project team member. - Responds to incidents, performs diagnosis, executes incident resolution for those requiring medium to high complexity. - Utilizes previous experience to reach resolution and will contribute to knowledge management system(s). Escalates issues when necessary. - Responds to customer requests received via the Service Management application. Fulfills requests of moderate to high complexity. Interacts with the customers in a courteous and professional manner. - Assists in the maintenance of and enters appropriate data into the device asset management system and the knowledge management systems to capture knowledge and work processes. - Responds to assigned issues and troubleshoots problems with desktops, laptops, tablets, mobile carts, printers and peripherals, including deployment of new devices. Identifies potential issues that could adversely impact end-user experience and takes corrective action. Participates in low complexity local and enterprise projects. Participates in on-call rotation and provides on-call support. - Performs proactive maintenance on devices. Participates in the 'smart hands program to assist other IT functional areas when needed. - General knowledge of Operational Level Agreements (OLAs) and always works within those metric - Day to day interactions with user community and works collaboratively with Business and IT Stakeholders as it relates to Incident Management, Request Fulfillment and Problem Management. - Understanding and adherence to policies and procedures. Contributes to new or modified policies. - Provides guidance, training and problem solving assistance to other team members. - Performs other duties as assigned.   End User Technician III - Provides the desktop hardware deployment and implementation of low to medium complexity and cross functional programs or projects and/or provides support for the user community with high complexity. - Performs troubleshooting for highly complex hardware, software and system problems for multiple device types. - Works on multiple projects as a project team member. Acts as a subject matter expert in one or more areas. - Responds to incidents, diagnoses and resolves complex problems and provides guidance to other team members. Contributes to knowledge management database for problem reporting and resolution. Escalates issues when necessary. Integrates with problem management and performs root cause analysis when necessary. - Responds to customer requests of high complexity. Interacts with the customers in a courteous and professional manner. - Maintains the device asset management system and the knowledge management systems to capture knowledge and work processes. - Responds to assigned issues and participates in the advanced troubleshooting and deployment of new devices, upgrades, fixes and new installations. Provides feedback on technical process issues to improve overall service delivery. Participates in local and enterprise projects of low to moderate complexity. May coach and advise other team members. Participates in on-call rotation and provides on-call support. - Exhibits knowledge of advanced desktop services skills. Ability to work closely with cross-functional IT teams on complex issues. Continues to build solid understanding of processes, procedures, and Dignity Health standards. - May assist in the development of Operational Level Agreements (OLAs). Monitors deviations and escalates issues to more senior team members. - Day to day interactions with user community and works collaboratively with multiple Business and IT Stakeholders as it relates to Incident Management, Request fulfillment and Problem Management, and Project delivery on small to medium size project. - Understanding and adherence to policies and procedures. Develops new or modifies existing policies. - Demonstrates potential leadership qualities through team motivation, coaching, and mentoring. - Performs other duties as assigned.   End User Technician IV - Provides desktop hardware support expertise and direction in the implementation of highly complex / enterprise wide cross functional programs or projects. May lead team to resolution of highly complex problems. - Leads the team in troubleshooting of highly complex hardware, software and system problems. - Works or coordinates on multiple projects, engaged in enterprise wide projects as a team member, sometimes a team leader. Acts a subject matter expert for multiple areas. - Oversees the End User Services team to ensure customer and production support needs are achieved. - Diagnoses and resolves highly complex issues and provides guidance to other team members. Leads team in problem resolution activities. - Works with leadership to develop strategies for problem reporting and resolution to be used by both the customer and team. - Responds to customer requests of high complexity, typically requiring high-level customer service to facility administration and/or VIPs. Interacts with customers and business stakeholders in a courteous and professional manner. Generates activity and status reports. Oversees the request fulfillment functions of the team. - Ensures the accuracy of information input in the device asset management system. Oversees the team knowledge management contributions and identification of critical knowledge, availability and use. - Leads the team in assigning issues, troubleshooting, and deployment of new devices, upgrades, fixes and new installations. Works with Site Directors and project leaders to staff and execute moderate to highly complex, enterprise solutions. - Serves as an escalation and issue resolution point for team members. Coordinates with facility and IT leadership regarding readiness and delivery issues. - Possesses a deep knowledge of all aspects of desktop services, utilizes advanced principles to deliver End User Services support to their customers and to advice and mentor team members. Extensive understanding of Dignity Health processes, policies, procedures and standards, and ensures team compliance. - Interfaces with customers on Operational Level Agreements (OLAs) and monitors and reports on deviations. Ensures proper monitoring and reporting of OLA deviations. - Day to day interactions with user community and works consistently with all levels of the Business and  IT Stakeholders as it relates to Incident Management, Request fulfillment, Problem Management and Project Delivery of medium to highly complex enterprise scale projects. Seeks opportunities for improvement in adherence to OLA's and Customer Satisfaction. - Understanding and adherence to policies and procedures. Ensures team understanding and adherence to those policies and procedures. - Demonstrates leadership through team motivation, coaching, mentoring, and delegating. - Perform other duties as assigned.  
Job ID
2020-146424
Department
Information Technology
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Finance Business Analyst III serves as the internal consultant between the business and Finance department. They provide high-level analysis and evaluation of business data, processes, and define report and data requirements. They will perform quality checks to confirm positive data integrity of reports, dashboards, and data extracts. When data anomalies are identified, the Business Analyst III collaborates with the business and finance team to correct and provide accurate, actionable information. As the internal consultants, the Business Analyst III develops relationships with key stakeholders to understand the business needs and bridge the gap with the Finance department, identifying opportunities to improve, develop, maintain and continuously monitor business performance.   The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Flexible work from home options considered!   #missioncritical #LI-Remote
Job ID
2021-161464
Department
Finance
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Finance Business Analyst III serves as the internal consultant between the business and Finance department. They provide high-level analysis and evaluation of business data, processes, and define report and data requirements. They will perform quality checks to confirm positive data integrity of reports, dashboards, and data extracts. When data anomalies are identified, the Business Analyst III collaborates with the business and finance team to correct and provide accurate, actionable information. As the internal consultants, the Business Analyst III develops relationships with key stakeholders to understand the business needs and bridge the gap with the Finance department, identifying opportunities to improve, develop, maintain and continuously monitor business performance.   The purpose of Dignity Health Management Services Organization (Dignity Health MSO) is to build a system-wide integrated physician-centric, full-service management service organization structure. We offer a menu of management and business services that will leverage economies of scale across provider types and geographies and will lead the effort in developing Dignity Health’s Medicaid population health care management pathways. Dignity Health MSO is dedicated to providing quality managed care administrative and clinical services to medical groups, hospitals, health plans and employers with a business objective to excel in coordinating patient care in a manner that supports containing costs while continually improving quality of care and levels of service. Dignity Health MSO accomplishes this by capitalizing on industry-leading technology and integrated administrative systems powered by local human resources that put patient care first. Flexible work from home options considered!   #missioncritical #LI-Remote   "finance manager" "finance analyst" 
Job ID
2021-161459
Department
Finance
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
What You’ll be Responsible For in this Role – Your Contribution & Career Journey The Information Technology Compliance Analyst applies knowledge of industry-specific information security regulations and principles of information systems management and security to ensure compliance and achieve optimal information security.  The Information Technology Compliance Analyst will be called upon to coordinate all compliance related activities in support of the corporate HIPAA Security regulations and the IT department’s policies and procedures.  What We’re Looking For - Proactively identifies and escalates incidents as well as operational performance concerns. - Manage workload, prioritizing tasks and documenting time, and other duties as directed by management. - Assists in Continual Service Improvement efforts by identifying opportunities for process improvement - Pursue continuing education to grow and maintain knowledge of best practices, compliance requirements, threats and trends in information security, translating into operational action items, policies, procedures, standards and guidelines as part of the IT Security team - Act as a security advocate for IT operations team’s adherence to Dignity Health policies and industry best practices. - Participate in the collection and documentation of departmental knowledge artifacts, participant in the population of knowledge management and collaboration systems for the IT Security team. - Communicates technical information to team members. - Assists Management in identifying knowledge gaps and providing training to Analysts and Technicians in the IT Security organization as directed. #LI-DH    
Job ID
2021-166747
Department
Information Technology
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Manager is external facing and manages Quality Data Abstrction and Value Based Coding staff. Oversee the daily, onsite, management activities of the Quality Data Abstraction and Value Bassed Coding staff. Act as liaison for ACN with appropriate involvement and escalation to ACN director and executives. Adhearing to policies related to quality metric achievement, clinical performace improvement and population health activities. Facilitate stakeholder participation in program with on-going education and technical assistance. Act as a subject matter expert/liaison for quality metrics value based coding activities related to ACN business operations. Other duties as assigned.  
Job ID
2021-168929
Department
Clinical Integration
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
AZ-Phoenix
Responsible for meeting all of the MCS Job Standards described below. Overall accountability for ensuring the design and development of claims workflow, policies and procedures as well as make appropriate recommendations that will positively impact operational effectiveness. Responsible for meeting and exceeding operational productivity standards and for ensuring that claims are processed within the timeliness guidelines, while ensuring accuracy and quality. Ensure proper utilization of human and system resources to achieve stated performance objectives for productivity, quality, data integrity and financial controls within budgetary constraints. Provides assistance to senior management in the implementation of new business objectives and the completion of the QNXT migration. Participate in organizational planning, including development and revision of action plans and outcomes evaluation as appropriate. Responsible for a full range of activities which ensure the operational effectiveness and excellence of the claims department as a whole. Must work in conjunction with other departments to achieve business objectives and resolve issues. Ensures financial objectives and controls are satisfied regarding distribution of claim payment checks and support documentation. Works with senior management on the development of the annual budget. Meets with external clients, providers, and/or employers to address claim related issues (i.e., Joint Operation Committee meetings with contracted health plans, quarterly provider meetings, workshops, etc.) Performs other duties as assigned. 
Job ID
2021-162656
Department
Claims Processing
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Redlands
The Manager, Utilization Management conducts medical reviews for necessity, level of care, and benefit reviews rendered in the inpatient and outpatient setting to ensure the patient receives the highest level of care. Coordinates with providers, provider staff, and hospital staff, patients and patient family members to establish an appropriate level of care.
Job ID
2021-164856
Department
Utilization Review
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The is responsible for providing clinical expertise and business direction in support of management programs to promote the delivery of high quality, constituent responsive . Provides technical expertise in management by direct decision making in the areas of:  preauthorization, concurrent review of hospitalized patients, discharge planning, complex case and chronic management.  This position is responsible for all UM and QM activities including, but not limited to developing clinical guidelines, measuring adherence to guidelines, and communicating and quality concerns on specific cases to the provider network.  Remote opportunity: Position can be located in California, Arizona or Nevada     Director, Operations, Cardiovascular, Ambulatory, Service Line, Utilizatio Management, Management Services, Managed Care, HMO, Provider Services, MD   ~DH-LI #missioncritical
Job ID
2020-146909
Department
Medical Director
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Member Services Representative is responsible for answering incoming telephone calls from health plan members, employers, providers and health plans. Assesses purpose of call and provides appropriate information to callers, including calls of a complex nature.
Job ID
2021-159429
Department
Member Services
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The Quality Management Nurse provides direct local service area support to the Clinical Integration (CI) program.  The QM Nurse reports to the SCQCN Executive Director and is an employee of Dignity Health Managed Services Organization. The QM Nurse provides local support to the CI Program through continuous interaction and education with the participating physicians and mid-level providers, as well as hospital QM staff. This positions serves the Santa Cruz County area.   What you can expect from working with our team: - Provide leadership with support on performance improvement and development of remediation plans at the local service area level. - Working closely with Physician Practice Liaison to provide physician office staff education regarding support for physician in implementing clinical initiatives undertaken within the physician’s area of specialty. - Provide one-on-one education on use of dashboard reports and other communications as appropriate to identify potential improvements and assist physicians in understanding methods and processes required to achieve measurable results. - Collaborate with leadership in preparing analyses, as well as monitoring, interpreting, and educating on results of clinical (ambulatory and hospital) quality, cost and utilization data.     #MISSIONCRITICAL
Job ID
2021-159631
Department
Quality Management
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Scotts Valley
Arizona Care Network (ACN) is a clinically integrated physician network and is a Dignity Health and Abrazo Health (Tenet) physician collaboration. The Senior Population Health Analyst supports ACN’s population health initiatives by analyzing and compiling data from multiple systems and presenting the analysis in a meaningful format. The analysis will cover many areas of health care data including clinical, quality and financial. The Senior Population Health Analyst has an understanding of population health analytics, and an understanding of clinical and claims based data systems and measures. This position will use ACN’s claim data warehouse, population health tools, electronic health record, and other reporting systems to provide clinical and claims related reporting and analytics. The Senior Population Health Analyst will provide support for data integrity and data validation in the production of data that drives operations, financial and quality queries.   #missioncritical  SQL, Qlik/Tableau/Power BI, Midas, naviHealth, Athena, Point Right, Strategic Healthcare Programs (SHP), Cerner, McKesson HPM, SAS, SQL, PHM
Job ID
2021-163504
Department
Population Health Management
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
AZ-Phoenix
The System Engineer II will provide operational support in addition to evaluation and implementation services for new products, technologies and solutions to address corporate business requirements. Works beyond the routine utilizing specialized knowledge and analysis of multiple variables. Has a comprehensive understanding and skillsets for supported platforms/products and environments.
Job ID
2020-143348
Department
Information Technology
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
The utilization review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality, cost-effective care which will enable patients to achieve maximum medical improvement while receiving care deemed medically necessary.
Job ID
2020-142640
Department
Utilization Review
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Bakersfield
As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. The goal of care coordination is to assist in managing care, cost, and outcomes across the continuum of patient care as it relates to acute inpatient stay and post-acute facility stay. The Utilization Review RN Coordinates continuing care/outside services for value based risk members (HMO members) in collaboration with the hospital and primary care physician. The Utilization Review RN is responsible to repatriate stable members from nonmember facilities in the emergency department and inpatient setting. This role monitors the patients in Skilled Nursing Facilities and out of network admissions using InterQual and makes assessments regarding appropriate lengths of stay. The process also involves screening for appropriateness of care and talking to the outside physicians to establish stability to and appropriateness of transfer. The Utilization Review RN coordinates and promotes an appropriate post-hospitalization treatment plan and evaluates effectiveness. The position possesses proficient knowledge of evidenced based criteria such as Interqual to review for appropriate care. The implementation of sound clinical, fiscal, and operational strategies is critical to the continued delivery of quality services. Care coordination principles provide an opportunity to balance care with cost. The Utilization Review RN interacts with multiple disciplines to assure high quality, cost efficient care utilizing available resources for Dignity Health members.
Job ID
2021-167420
Department
Utilization Review
Facility
Dignity Health Management Services Organization
Shift
Day
Employment Type
Full Time
Location
CA-Redlands

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