Qureos Mentor

Connecticut Children's

<div><div>Connecticut Children&rsquo;s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children&rsquo;s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members. 
</div><div></div> 
<div>At Connecticut Children&rsquo;s, treating children isn&rsquo;t just our job &ndash; it&rsquo;s our passion. As a leading children&rsquo;s health system experiencing steady growth, we&rsquo;re excited to expand our team with exceptional team members who share our vision of transforming children&rsquo;s health and well-being as one team.</div></div>
 <div>Under the direct supervision of a Registered Nurse as part of an inpatient/hospital unit, performs a variety of routine direct patient care, environmental and administrative support activities to promote the health, safety and comfort of patients and families. All patient care and support activities are completed in accordance with CCMC and unit policies and procedures.</div>
 <div><ul><li>Direct Patient Care - Provides direct patient care (as defined by unit) that addresses the population-specific needs of the patients on the unit. Activities may include any of the following: assist patient with feedings and personal care (e.g. hygiene, ambulating and activities of daily living, etc.); obtain vital signs, temperature, weight, height, head circumference or other patient data as required; obtain and test specimens (e.g. blood glucose, urine, etc.); transport patients; assist with patient admissions and discharges. Demonstrates an awareness of safety needs and a basic knowledge of medical terminology, infection control, risk management and environment of care policies in all interactions with patients/families. Responds with tact and discretion to the needs of patients and families, and reports needs beyond the PCA skill level to the RN.
</li><li>Documentation - Accurately documents patient information on appropriate forms. Demonstrates basic data entry and data retrieval competency in electronic patient records and/or patient supply systems utilized on unit.
</li><li>Unit Support Activities - Maintains appropriate inventories of unit supplies in patient rooms/bedside stands; and in treatment, utility, medication and linen rooms. Cleans, maintains and inventories unit equipment. May perform quality control checks on equipment or supplies as directed by the RN. Utilizes all equipment appropriately, and notifies appropriate person of equipment or facility breakdown or damage. Assist with miscellaneous errands, and transportation of medication (including controlled substances) blood, equipment and supplies, as directed by the RN. Assist with routine clerical tasks.
</li><li>Demonstrates knowledge of the population-specific differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice. Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.
</li><li>Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS</li></ul></div>
 <div>Education and/or Experience:
<ul><li>Education Required: High school diploma, GED or equivalent, or high level of education that requires a high school diploma
</li><li>Experience Preferred:
<ul><li>Successful completion or enrollment in a Certified Nurse&rsquo;s Aide training program, completion of a Medical Assistant program, or EMT certification strongly preferred.
</li><li>Minimum of one year pediatric PCA experience preferred
</li></ul></li></ul>License and/or Certification:
<ul><li>BLS/CPR, American Heart Association, required within 2 weeks of hire and must remain current at all times. Certified Nurse Aide (CNA) certification by State of Connecticut preferred.
</li><li>Nonviolent Crisis Intervention training certification required within 3 months of hire and maintained thereafter.
</li></ul>Knowledge, Skills and Abilities Required:
Knowledge of:
<ul><li>Basic medical terminology preferred.
</li><li>Basic math and measurements.
</li><li>Basic understanding of organization&rsquo;s environment of care and infection control policies and procedures.
</li></ul>Skills:
<ul><li>Good interpersonal and communication skills.
</li></ul>Ability to:
<ul><li>Effectively communicate both orally and in writing in English demonstrating a command of basic grammar and spelling is required; ability to communicate Bilingually (Spanish/English) is preferred.
</li><li>Understand and follow specific written and verbal instructions and procedures.
</li><li>Learn and demonstrate competency in standard clinical procedures within specialty area, according to established protocols.
</li><li>Maintain quality, safety, and/or infection control standards.
</li><li>Learn and follow established protocols in order to initiate appropriate action in emergency/crisis situations
</li><li>Learn and demonstrate competency in basic data entry/data retrieval in electronic patient records and/or patient supply systems utilized on unit.</li></ul></div>

Patient Care Assistant-MS8-36hrs

<div>
 
 Job Description
 
 
 
 
 Applicants must be residents of Connecticut, Massachusetts, or New York to be considered for this position.
 
 
 
 
 The Center
 
 
 
 Connecticut Children&rsquo;s Center for Care Coordination (The Center) is dedicated to the integration of care coordination through the delivery of innovative programs, providing technical assistance, disseminating best practices, and building inclusive partnerships to strengthen families and build stronger communities. The Center utilizes a universal, evidence based, research informed, and policy driven approach to enhanced care coordination that not only meets the interrelated medical, developmental, behavioral, and social needs of children, but enhances the care giving capacity of families. This team reports to The Center for their leadership.
 
 
 
 Position Details
 
 
 
 The Portal of Entry Utilization Management Nurse (POE) has strong clinical skills and a well-developed knowledge of utilization management, with a focus on medical necessity determinations. The candidate should possess a working knowledge of medical necessity tools such as InterQual&reg; and Milliman Care Guidelines&reg; and be proficient in medical record reviews. This individual supports the Care Management program by developing and/or maintaining effective and efficient processes for determining the defensible hospitalization status based on regulatory and reimbursement requirements of various commercial and government payers. The purpose of the POE is to support the physician and other qualified practitioners in determination of defensible patient class at the time of admission in the ED. The POE serves as a resource to all members of the health care team on defensible patient status and promotes effective utilization of hospital resources.
 
 
 This individual maintains current and accurate knowledge regarding commercial and government payers including regulatory requirements. The POE nurse will function in accordance with facility policies and processes. This individual will support process improvement activities and report key metrics to facility leadership as requested. audiences. The POE Nurse effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment. The POE Nurse participates and provides support to the hospital&rsquo;s Utilization Management Committee. They collaborate with multiple leaders at various levels throughout the organization. This is an on-site role interfacing with the admitting physician on cases to support industry-accepted level of care criteria.
 
 
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Performs chart review of assigned patients to identify quality, timeliness, and appropriateness of patient care. Conducts hospitalization reviews based on appropriate guidelines. Uses these criteria to screen for defensible level of care based on medical record documentation. Escalates cases as appropriate for secondary review. -15%
 </li>
 <li>
 Adheres to CMS guidelines for utilization reviews as evidenced by utilization of the relevant guidelines and appropriate referrals for secondary review. Identifies, develops, and implements strategies to reduce length of stay and resource consumption in conjunction with discharge planning staff. -15%
 </li>
 <li>
 Provides consultation and education to physicians and other qualified practitioners regarding medical record documentation necessary to support the ordered level of care. -10%
 </li>
 <li>
 Performs and documents initial / admission medical necessity review for all points of entry. -10%
 </li>
 <li>
 Communicates initial medical necessity review results with emergency department and admitting providers as necessary to support defensible admission status orders. -10%
 </li>
 <li>
 Proactively collaborates with emergency department providers and staff to identify patients likely to require hospitalization. -10%
 </li>
 <li>
 Works in conjunction with emergency department social workers and other staff to identify and secure available and necessary services to support clinically appropriate hospital admission avoidance. -3.0%
 </li>
 <li>
 Obtains information from patient, caregivers, providers of services, insurance company, benefits administrators and others as necessary. - .5%
 </li>
 <li>
 Conveys benefit data and options, programs and other forms of assistance that may be available to the patient, and negotiates for services as indicated. -.5%
 </li>
 <li>
 Communicates pertinent reimbursement information to healthcare team while observing patient right to confidentiality. -.5%
 </li>
 <li>
 Verifies in-network verses out-of-network benefits and communicates data to the patient and healthcare team as indicated. -.5%
 </li>
 <li>
 Pre-Admission Reviews -15%
 </li>
 <ul>
 <li>
 Performs prospective medical record review of patients scheduled for outpatient/inpatient procedures scheduled in the hospital setting.
 </li>
 <li>
 Works in collaboration with Finance to identify the appropriate setting for scheduled admissions, procedures, and medication administration by reviewing pertinent clinical information and collaborating to obtain prior authorization when necessary.
 </li>
 <li>
 Screens scheduled patients to ensure that they are scheduled in a defensible utilizing industry-accepted level of care criteria.
 </li>
 <li>
 Is able to review and interpret the patient&rsquo;s medical record to supply appropriate information to third-party payers as necessary.
 
 
 
 </li>
 </ul>
 </ul>
 Additional Responsibilities -5%
 
 
 <ul>
 <li>
 Collaborates with other members of The Center team to coordinate the right care, in the right setting, at the right time for CT Children&rsquo;s patients.
 </li>
 <li>
 Assist with discharge planning as necessary to coordinate the right care, in the right setting and the right time for CT Children&rsquo;s patients.
 </li>
 <li>
 Identify gaps in care/resources and address issues that negatively impact access to care, services, and resources
 </li>
 <li>
 Function as a change agent, advocate, and resource person for family and healthcare team to identify and resolve performance improvement issues within the system.
 </li>
 <li>
 Commitment to ONE TEAM Culture. -2.5%
 </li>
 <li>
 Performs other job-related duties as assigned. -2.5%
 
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 
 Education and/or Experience Required:
 
 
 
 <ul>
 <li>
 Education: Bachelor of Science in Nursing (BSN)
 </li>
 <li>
 Experience: 3 years of nursing experience in a healthcare setting
 
 
 
 </li>
 </ul>
 
 Education and/or Experience Preferred:
 
 
 
 <ul>
 <li>
 Experience:
 </li>
 <ul>
 <li>
 Pediatric nursing experience
 </li>
 <li>
 Previous experience in Utilization Review
 </li>
 <li>
 Previous experience in Case Management or Discharge planning
 
 
 
 </li>
 </ul>
 </ul>
 
 License and/or Certification Required:
 
 
 
 <ul>
 <li>
 State if Connecticut Nursing License.
 
 
 
 </li>
 </ul>
 
 License and/or Certification Preferred:
 
 
 
 <ul>
 <li>
 Case Management Certification.
 
 
 
 </li>
 </ul>
 
 Knowledge, Skills and Abilities:
 
 
 
 Knowledge:
 
 
 <ul>
 <li>
 Demonstrate working knowledge of how to interpret and apply medical care criteria.
 </li>
 <li>
 Knowledge of community resources, treatment options, home health availability, funding options and special programs.
 
 
 
 </li>
 </ul>
 Skills:
 
 
 <ul>
 <li>
 Coordinates management of care for a specified patient population; follows patients throughout the continuum of care and ensures optimum utilization of resources, service delivery and compliance with hospital standards
 </li>
 <li>
 Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs.
 </li>
 <li>
 Skilled in the operation of the computer including proficiency in Microsoft Office Word, ability to use/update Excel spreadsheets and ability to navigate EPIC.
 
 
 
 </li>
 </ul>
 Abilities:
 
 
 <ul>
 <li>
 Self-directed/motivated, organized, diplomatic and team-oriented.
 </li>
 <li>
 Function in a high energy, fast moving environment.
 </li>
 <li>
 Maintain flexibility as determined by acuity of medical unit.
 </li>
 <li>
 Prioritize case load.
 </li>
 <li>
 Collaborate with various disciplines.
 </li>
 <li>
 Communicate effectively and efficiently.
 </li>
 <li>
 Prioritize and manage multiple tasks.
 </li>
 <li>
 Excellent written and verbal communication skills.
 
 
 
 </li>
 </ul>
 
 About Us
 
 
 
 Connecticut Children&rsquo;s is the only health system in Connecticut that is 100% dedicated to children. Established on a legacy that spans more than 100 years, Connecticut Children&rsquo;s offers personalized medical care in more than 30 pediatric specialties across Connecticut and in two other states. Our transformational growth establishes us as a destination for specialized medicine and enables us to reach more children in locations that are closer to home. Our breakthrough research, superior education and training, innovative community partnerships, and commitment to diversity, equity and inclusion provide a welcoming and inspiring environment for our patients, families and team members.
 
 
 At Connecticut Children&rsquo;s, treating children isn&rsquo;t just our job &ndash; it&rsquo;s our passion. As a leading children&rsquo;s health system experiencing steady growth, we&rsquo;re excited to expand our team with exceptional team members who share our vision of transforming children&rsquo;s health and well-being as one team.
</div>

Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite

Join Connecticut Children's and explore 2   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.

Connecticut Children's

About Company

Patient Care Assistant-MS8-36hrs

Portal of Entry (ED) Utilization Management Nurse- 32hr- Onsite