Rn - clinical decision Job at Providence Swedish (Olympia)

Clinical Policy Clinical Coder Rn Ii

The Clinical Policy Clinical Coder RN II is responsible for analyzing, interpret...

Location

United States , Los Angeles

Salary:

102183.00 - 163492.00 USD / Year

L.A. Care Health Plan

Expiration Date

Until further notice

Requirements

Associate's Degree in Nursing
At least 8 years of experience in Clinical Nursing
At least 3 years of experience with Medi-Cal and Medicare in a managed care environment
Experience in performing and creating clinical documentation
Experience in regulatory compliance for a health plan
Experience with medical coding systems
Proficient with clinical policy through skills in literature searching and clinical research analysis based on the best available evidence
Working knowledge of clinical policies
Working knowledge of CPT/HCPC codes and claims
Ability to translate regulatory requirements into auditable tools

Job Responsibility

Translate approved clinical policies and utilization management criteria into clear, codified claims rules and system logic to support accurate claims adjudication
Develop, revise, and recommend clinical policies and internal utilization management criteria when standard clinical guidelines are insufficient to support appropriate decision-making based on codified claim rules
Assess the downstream claims impact of new or revised clinical policies prior to implementation and recommend configuration updates to mitigate operational or financial risk
Participate in validation of claims configuration changes to ensure policies are applied correctly and consistently across all lines of business
Monitor post-implementation claims activity to identify configuration issues, unintended denials, or payment discrepancies related to clinical policy application
Support remediation of claims configuration defects by identifying root causes and coordinating corrective actions with internal teams
Participate in and lead specialty and cross-functional workgroups and committees focused on healthcare services clinical policies, utilization management processes, strategic initiatives, policy governance, operational alignment, and continuous improvement efforts
Ensure timely dissemination of accurate and consistent policies and procedures across departments
Promote collaboration, engagement, and a positive work environment while supporting departmental initiatives and team-based activities
Manage assigned projects from concept through implementation, ensuring timelines, quality standards, and deliverables are met

What we offer

Paid Time Off (PTO)
Tuition Reimbursement
Retirement Plans
Medical, Dental and Vision
Wellness Program
Volunteer Time Off (VTO)

Fulltime

Registered Nurse - Clinical Decision Unit

Registered Nurse - Clinical Decision Unit. Tucson Medical Center is currently se...

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

Current RN licensure permitting work in the State of Arizona and Basic Life Support (BLS) certification required
Additional certification may be required per department
One (1) year of nursing experience in an acute care setting preferred
Knowledge of direct patient care and critical care procedures and techniques, tools, and responses required to ensure optimal patient care
Knowledge of exam indicators, contraindications, and patient preparation
Skill in communicating in a clear and concise manner with staff involved in critical care, and physicians to ensure the proper care of patients
Skill in reading 12-lead EKG
Skill demonstrated in assigned disciplines such as EP, directly involved in patient care
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to complete routine reports and correspondence

Job Responsibility

Provides direct patient care, evaluates outcomes, consults with other specialists as required and adjusts nursing care processes as indicated to ensure safe patient care
Writes or obtains initial nursing histories, assesses patients' conditions and develops individual care plans
maintains patient documentation
Receives and reviews preceding shift reports and floor nurse reports
makes complete rounds of all units, and notes patients' condition
Notifies appropriate physician regarding any unusual or unexpected events or problems requiring direct physician consultation
Works with other members of the interdisciplinary patient care team, implements and reinforces patient instructional needs with patient and family offering informational material and pointing out special areas of concern
Evaluates outcomes of patient care, consults with other specialists as needed and adjusts nursing care processes as necessary to ensure optimal patient care
Identifies and resolves workplace health and safety issues
Provides appropriate, direct patient care utilizing appropriate aseptic techniques

Fulltime

Hospice RN Clinical Management Specialist

The RN Clinical Management Specialist is a qualified professional responsible fo...

Location

United States , Pelham

Salary:

85000.00 - 100000.00 USD / Year

Aveanna Healthcare

Expiration Date

Until further notice

Requirements

Registered Nurse with an active and unencumbered license in the state of residence
Expertise and experience with the Homecare Homebase (HCHB) EMR system
Three (3) years of clinical experience within the last five (5) years in Hospice
Homecare Homebase (HCHB) experience is preferred
Valid and acceptable driver’s license with proof of automobile insurance coverage
Travel by car between regional offices will be required

Job Responsibility

Monitors and assesses company electronic medical records (EMR) workflows and assists as needed or assigned
Provides support with the intake process and admission decisions
Facilitates virtual training for newly hired/rehired/promoted Clinical Managers and Nurses
Serve as interim Clinical Manager when position is vacant
Act as mentor for new Clinical Managers

What we offer

401(k) with Company match
Health, Dental, and Vision Benefits
Vacation Time, Sick Time, and Paid Holidays

Fulltime

Registered Nurse - Clinical Decision Unit

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

Current RN licensure permitting work in the State of Arizona and Basic Life Support (BLS) certification required
One (1) year of nursing experience in an acute care setting preferred
Bachelor’s degree preferred
Additional certification may be required per department

Job Responsibility

Coordinates patient care planning with other disciplines utilizing the principles of the nursing process and critical thinking skills in order to maintain patient safety and well-being
Provides direct patient care, evaluates outcomes, consults with other specialists as required and adjusts nursing care processes as indicated to ensure safe patient care
Writes or obtains initial nursing histories, assesses patients' conditions and develops individual care plans
maintains patient documentation
Receives and reviews preceding shift reports and floor nurse reports
makes complete rounds of all units, and notes patients' condition
Notifies appropriate physician regarding any unusual or unexpected events or problems requiring direct physician consultation
Works with other members of the interdisciplinary patient care team, implements and reinforces patient instructional needs with patient and family offering informational material and pointing out special areas of concern
Evaluates outcomes of patient care, consults with other specialists as needed and adjusts nursing care processes as necessary to ensure optimal patient care
Identifies and resolves workplace health and safety issues

What we offer

$10,000.00 Sign On Bonus w/2 Years Experience

Fulltime

Registered Nurse - Clinical Decision Unit

Tucson Medical Center is currently seeking medical professionals to work on our ...

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

Current RN licensure permitting work in the State of Arizona
Basic Life Support (BLS) certification required
Additional certification may be required per department
Knowledge of direct patient care and critical care procedures and techniques, tools, and responses required to ensure optimal patient care
Knowledge of exam indicators, contraindications, and patient preparation
Skill in communicating in a clear and concise manner with staff involved in critical care, and physicians to ensure the proper care of patients
Skill in reading 12-lead EKG
Skill demonstrated in assigned disciplines such as EP, directly involved in patient care
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals
Ability to complete routine reports and correspondence

Job Responsibility

Coordinates patient care planning with other disciplines utilizing the principles of the nursing process and critical thinking skills in order to maintain patient safety and well-being
Provides direct patient care, evaluates outcomes, consults with other specialists as required and adjusts nursing care processes as indicated to ensure safe patient care
Writes or obtains initial nursing histories, assesses patients' conditions and develops individual care plans
maintains patient documentation
Receives and reviews preceding shift reports and floor nurse reports
makes complete rounds of all units, and notes patients' condition
Notifies appropriate physician regarding any unusual or unexpected events or problems requiring direct physician consultation
Works with other members of the interdisciplinary patient care team, implements and reinforces patient instructional needs with patient and family offering informational material and pointing out special areas of concern
Evaluates outcomes of patient care, consults with other specialists as needed and adjusts nursing care processes as necessary to ensure optimal patient care
Identifies and resolves workplace health and safety issues

Fulltime

Registered Nurse Clinical Decision Unit

Join our team as a day shift, full-time, Medical Surgical Clinical Decision Regi...

Location

United States , Topeka

Salary:

Not provided

Ardent Health

Expiration Date

Until further notice

Requirements

Current Kansas RN Licensure
Associate’s degree in nursing
BLS certification must be obtained within 14 days of hire or transfer into the role and prior to providing direct patient care
Tele, ICU, and PCU require ACLS
Post-surgery requires oncology certification
All required certifications must be completed within the first year of employment

Job Responsibility

The Registered Nurse functions under the direction of the Nurse Director/Manager and is responsible for coordination of safe patient care delivery for specified and diverse patient populations
The RN assesses patient/family needs, develops and prioritizes patient goals, evaluates care delivery, and continually revised the plan of care to meet the biological, emotional, psychosocial, spiritual, developmental, and educational needs of the patient/family
The RN Delegates care as appropriate to optimize patient outcomes
The RN adheres to the Kansas Nurse Practice Act

What we offer

Career growth opportunities
Tuition assistance
Resources that support wellness, education, and financial well-being
Paid time off
Comprehensive health benefits
Supportive, inclusive culture

Fulltime

RN Clinical Manager

RN Clinical Manager - Home Health. Full-time days. Are you looking for a rewardi...

Location

United States , Stroud

Salary:

80000.00 - 95000.00 USD / Year

Amedisys

Expiration Date

Until further notice

Requirements

Associate or bachelor's degree in nursing
Current RN license, specific to the state(s) you are assigned to work
One year of clinical RN experience in home health or hospice
One year of RN management experience
Current CPR certification

Job Responsibility

Recommends employment decisions for staff to the director of operations, including decisions to hire, fire, advance, promote or change status
Responsible for overall quality of patient care and clinical performance of nurses and aides
Organizes clinical operations for the care center
Reviews requests for services and determines patient eligibility/suitability for home care services
Works with intake in coordinating patient referrals and admissions
Oversees scheduling
Oversees payor verification and precertification requirements
Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved
Assists clinicians in establishing immediate and long-term patient goals, setting priorities and developing Plan of Care (POC)
Regularly evaluates the needs of the patient and makes necessary revisions to the plan of care in collaboration with clinicians

What we offer

A full benefits package with choice of affordable PPO or HSA medical plans
Paid time off
Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan
Up to $500 in wellness rewards for completing activities during the year
Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program
401(k) with a company match
Family support with infertility treatment coverage, adoption reimbursement, paid parental and family caregiver leave
Fleet vehicle program (restrictions apply) and mileage reimbursement

Fulltime

RN Clinical Manager Home Health

Are you looking for a rewarding career in homecare? If so, we invite you to join...

Location

United States , St. Louis

Salary:

90000.00 - 105000.00 USD / Year

Amedisys

Expiration Date

Until further notice

Requirements

Associate or bachelor's degree in nursing
Current RN license, specific to the state(s) you are assigned to work
One year of clinical RN experience in home health or hospice
One year of RN management experience
Current CPR certification

Job Responsibility

Recommends employment decisions for staff to the director of operations, including decisions to hire, fire, advance, promote or change status
Responsible for overall quality of patient care and clinical performance of nurses and aides
Organizes clinical operations for the care center
Reviews requests for services and determines patient eligibility/suitability for home care services. Works with intake in coordinating patient referrals and admissions
Oversees scheduling
Oversees payor verification and precertification requirements
Reviews documentation of other staff members and ensures missing, incomplete and/or untimely documentation issues are resolved
Assists clinicians in establishing immediate and long-term patient goals, setting priorities and developing Plan of Care (POC)
Regularly evaluates the needs of the patient and makes necessary revisions to the plan of care in collaboration with clinicians
May provide direct patient care on an infrequent basis in times of emergency

What we offer

$20,000 Sign on Bonus
A full benefits package with choice of affordable PPO or HSA medical plans
Paid time off
Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan
Up to $500 in wellness rewards for completing activities during the year
Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program
401(k) with a company match
Family support with infertility treatment coverage, adoption reimbursement, paid parental and family caregiver leave
Fleet vehicle program (restrictions apply) and mileage reimbursement

Fulltime

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Rn - clinical decision

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