Remote Concurrent Review Nurse RN/LVN), Accountable Care II

Stanford Health Care

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1.0 FTE   Full time   Day – 08 Hour   R2334367   Remote   86242 PI-POPULATION HEALTH-HPO   Nursing   180 El Camino Real,PALO ALTO,California

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Day – 08 Hour (United States of America)This is a Stanford Health Care job.

A Brief Overview
Proactively manage inpatient and/or skilled nursing utilization to assure that medical care is appropriate, efficient, and medically necessary. Support facility discharge planning efforts, transfers and coordination of care.

Locations
Stanford Health Care

What you will do

  • Inpatient Utilization Management:
  • Conduct concurrent review of inpatient utilization at assigned facilities according to clinical criteria, and diligently complete retrospective review within specific time frames. Support proactive facility discharge planning, transfers, and redirection while identifying barriers to efficient hospital utilization and facilitate resolution. Reduce avoidable bed days use by applying applicable criteria and properly documenting decisions and issuing related correspondence.
  • Proactively and collaboratively interface with HMOs, physicians, internal staff, members and their families to assist in expediting appropriate discharge, including related bedside visits and post-discharge calls to members. Persuade hospital staff and physicians to adopt appropriate behavior to facilitate efficient and effective inpatient utilization while supporting a positive work environment and fostering teamwork.
  • Refer members to various other departments (i.e., Case Management, Disease Management, TPL, COB) for follow-up as appropriate.
  • Serve as a liaison between the hospital, health plan, vendors, and providers while managing individual market to determine opportunities to improve utilization, quality of care, access issues and physician profiling. Build and maintain appropriate relationships on behalf of AMS.
  • Administration & Compliance:
  • Properly request letters, including applying the appropriate legal and regulatory requirements for ICE and health plan specific letter templates.
  • Meet departmental review and documentation standards for work assignments while supporting AMS (Affinity Medical Group) authorizations process, clinical initiatives, and other activities.
  • Abide by and maintain telecommuting standards and adhere to the policy and procedures of assigned hospital(s). Also, meet CCR attendance and availability standards.
  • All other duties as assigned including department-specific functions and responsibilities.
  • Performs other duties as assigned and participates in organization projects as assigned.
  • Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.

Experience Qualifications

  • Three (3) years of Medical/Surgical clinical nursing experience.

Required Knowledge, Skills and Abilities

  • Proficient in Microsoft Office applications and other computer skills.
  • Excellent communication, organizational and time management skills with the ability to meet tight timeframes.
  • Ability to work effectively and collaboratively with a variety of customers including physicians, health plans, hospital/office staff, providers, and members.
  • Physically capable to go onsite and work in hospital environment, requiring lengthy walking, standing and carrying medical records.
  • Ability to work independently and apply critical thinking skills towards making appropriate decisions.
  • Ability to travel to work assignments.
  • Flexible and adaptable to change.
  • Ability to learn quickly and retain complex information.

Licenses and Certifications

  • Nursing\RN – Registered Nurse – State Licensure And/Or Compact State Licensure . or
  • LVN – Licensed Voc Nurse . and
  • CADL – California Drivers License – Valid And In State .

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

  • Know Me: Anticipate my needs and status to deliver effective care
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $62.69 – $83.07 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.

Saving Lives and Changing the Future of Medicine

Stanford is a part of the top 10 highest ranked Level 1 Trauma Magnet Facilities in the U.S. Combining clinical care, research, and education, our team provides compassionate, coordinated and personalized care for the unique needs of every patient. As the only Level I trauma center between San Francisco and San Jose, Stanford Health Care delivers clinical innovation across its inpatient services, specialty health centers, physician offices, virtual care offerings and health plan programs. With a state-of-the-art hospital, more than 2,800 medical staff and more than 1,300 residents and fellows, Stanford Health Care is committed to making a lasting impact through research, education and clinical care.

Benefits

Stanford offers exceptional benefits and competitive pay to ensure our staff feels supported in and outside of their work. Specific roles are eligible for shift differential pay, sign-on/relocation bonus, etc. For more information, please visit our Total Rewards page!