Qureos Mentor

Kindred Hospitals

<div>Description 
At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary
The Utilization Management Manager plays a vital role in ensuring patients have timely access to care by managing both front-end prior authorizations and in-house concurrent review authorizations. This position blends strong relationship-building skills with clinical knowledge to navigate complex payer requirements, streamline the authorization process, and support seamless patient transitions.
From start to finish, this role drives the authorization process&mdash;reviewing prospective, retrospective, and concurrent medical records; coordinating with referring hospitals to secure prior authorizations; and partnering with case management teams at ScionHealth facilities to complete concurrent review authorizations. Acting as a navigator and liaison between Business Development, facility administration, managed care organizations, and payors, the specialist ensures determinations are communicated promptly and accurately to all relevant stakeholders.
By combining attention to detail with proactive collaboration, the Utilization Management Manager safeguards revenue integrity, reduces delays, and supports the organization&rsquo;s mission of delivering exceptional patient care. This role actively contributes to quality improvement, problem-solving, and productivity initiatives within an interdisciplinary model, demonstrating accountability and a commitment to operational excellence.
Essential Functions<ul><li>
Extrapolates and summarizes essential medical information to obtain authorization for admission and continued stay to/at ScionHealth Level of Care.</li><li>
Prepares recommendations to sumbit timely request for reconsideration of denial determination in attempt to have denied authorization requests overturned.</li><li>
Ensures authorization requests are processed timely to meet regulatory timeframes.</li><li>
Reviews medical necessity assessments completed by case management, evaluating documentation for specific criteria related to severity of illness, and level of care appropriateness.</li><li>
Generates written appeals to medical necessity-based payor denials for denials prior to admission and concurrent review authorizations. Appeal letters may be processed on behalf of the physician, combining clinical and regulatory knowledge in efforts to have consideration of authorization.</li><li>
Documents authorization information in relevant tracking systems.</li><li>
Effectively builds relationships with business development team, admissions team/clinical staff and managed care team, to coordinate the patient admission functions in keeping with the mission and vision of the hospital.</li><li>
Supports review of patient referral for clinical and financial approval and/or escalation to leadership for approval following the Care Considerations grid.</li><li>
Coordinates and facilitates pre-admission Prior Authorizations for patients from the referral sources:<ul><li>
Identifies /reviews medical record information needed from referring facility.</li><li>
Applies appropriate clinical guidelines to pre-authorization determination process.</li><li>
Communicates specific patient needs for equipment, supplies, and consult services as related to prior authorization requirements.</li><li>
Acts as a liaison with the Business Development team through every stage of the authorization process through determination.</li><li>
Initiates appeals process as appropriate.</li><li>
Facilitates and coordinates physician-to-physician communication as appropriate to support the denial management process.</li><li>
Communicates to appropriate teams, including business development and facility administration when clinical authorization and financial approval is complete, following standard authorization process.</li></ul></li><li>
Provides hospital team with needed prior authorization information on pending / new admissions.</li><li>
Coordinate with managed care payor on all coverage issues and supports the LOA process as requested.</li><li>
Coordinates and facilitates Concurrent Review Authorizations for patients actively in-house at a ScionHealth facility<ul><li>
Identifies /reviews medical record information needed from facility.</li><li>
Applies appropriate clinical guidelines to concurrent review authorization process.</li><li>
Review medical necessity review information provided by the case management team and communicates any additinoal questions or information requests</li><li>
Acts as a liaison with the Case Management team through every stage of the concurrent review authorization process through determination.</li><li>
Initiates appeals process as appropriate.</li></ul></li><li>
Communicates with Medical Advisors or case managers of managed care company as necessary; including during Care Coordination / Managed Care calls</li><li>
Maintains a knowledge of areas of responsibility and develops and follows a program of continuing education.</li><li>
Participates in continuing education/ professional development activities.</li><li>
Learns and develops full knowledge of the CAAT Admission Processes and actively seeks to continuously improve them.</li></ul>
Knowledge/Skills/Abilities/Expectations<ul><li>
Strong relationship building skills and a spirit to serve to ensure effective communication and service excellence.</li><li>
Knowledge of regulatory standards and compliance guidelines.</li><li>
Working knowledge of medical necessity justification through but not limited to non-physician review guidelines (InterQual and Milliman), Medicare and Medicaid rules, regulations, coverage guidelines, NCDs and LCDs.</li><li>
Working knowledge of Medicare, Medicaid and Managed Care payment and methodology.</li><li>
Extensive knowledge of clinical symptomology, related treatments and hospital utilization management.</li><li>
Excellent interpersonal, verbal and written skills to communicate effectively and to obtain cooperation/collaboration from hospital leadership, as well as physicians, payors and other external customers.</li><li>
Critical thinking, problem solving, and decision-making capabilities with the ability to discern, collect, organize, evaluate, and communicate pertinent clinical information with effective verbal and written skills.</li><li>
Technical writing skills for appeal letters and reports.</li><li>
Effective time management and prioritization skills.</li><li>
Computer skills with working knowledge of Microsoft Office (Word, Excel, PowerPoint, and Outlook), word-processing and spreadsheet software.</li><li>
Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members.</li><li>
Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards.</li><li>
Communicates and demonstrates a professional image/attitude for patients, families, clients, coworkers and others.</li><li>
Adheres to policies and practices of ScionHealth.</li><li>
Must read, write, and speak fluent English</li><li>
Must have good and regular attendance.</li><li>
Approximate percent of time required to travel: N/A</li></ul> 

Qualifications 
Education<ul><li>
Postsecondary non-Degree (Cert/Diploma/Program Grad) of an Accredited School of Nursing required</li><li>
Associate&rsquo;s Degree in healthcare or related field required</li><li>
Bachelor&rsquo;s Degree in healthcare or related field preferred</li><li>
Equivalent combination of Education and/or Experience in lieu of education (3+ years in a related field) may be considered.</li></ul>
Licenses/Certifications<ul><li>
Healthcare professional licensure preferred.</li><li>
In lieu of licensure, 3+ years of experience in relevant field required.</li><li>
Some states may require licensure or certification.</li></ul>
Experience<ul><li>
3+ years of experience in a healthcare strongly preferred.</li><li>
Experience in managed care, case management, utilization review, or discharge planning a plus.</li></ul></div>

Utilization Management Manager REMOTE Pacific Region

<div>Description 
At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary<ul><li>
Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient&rsquo;s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process.</li></ul>
Essential Functions<ul><li>
Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department</li><li>
Directs, supervises, provides and evaluates nursing care provided to patients</li><li>
Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated</li><li>
Assigns nursing care team members in accordance with patient needs, team member&rsquo;s capabilities and qualifications</li><li>
Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient&rsquo;s medical record according to nursing standards and policies</li><li>
Performs assessment on all patients on admission and reassessments as per policy</li><li>
Makes referrals to other disciplines based on assessment</li><li>
Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team</li><li>
Assesses and reassesses pain</li><li>
Utilizes appropriate pain management techniques</li><li>
Educates the patient and family regarding pain management</li><li>
Revises the plan of care as indicated by the patient&rsquo;s response to treatment and evaluates overall plan daily for effectiveness</li><li>
Performs patient care responsibilities considering needs specific to the standard of care for patient&rsquo;s age</li><li>
Receives physician&rsquo;s orders, ensures transcription is accurate and documents completion</li><li>
Administers medication utilizing the five rights of medication administration reducing the potential for medication errors</li><li>
Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate</li><li>
Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice</li><li>
Performs treatments and provides services to level of licensure</li><li>
Treats patients and their families with respect and dignity</li><li>
Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families</li><li>
Functions as liaison between administration, patients, physicians, and other healthcare providers</li><li>
Interacts professionally with patient/family and involves patient/family in the formation of the plan of care</li><li>
Interprets data about the patient&rsquo;s status to identify each patient&rsquo;s age specific needs and provide care needed by the patient group</li><li>
Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors</li><li>
Initiates or assists with emergency measures for sudden adverse developments in patients&rsquo; condition</li><li>
Answers telephone, paging system, patients&rsquo; call lights, anticipates patients&rsquo; needs, and makes rounds of assigned patients and responds as appropriate</li><li>
Consults other departments as appropriate to provide for an interdisciplinary approach to the patient&rsquo;s needs</li><li>
Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off</li><li>
Communicates appropriately and clearly to management, co-workers, and physicians</li><li>
Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs</li><li>
Participates in orientation, instruction/training of new personnel</li><li>
Manages and operates equipment safely and correctly</li></ul>
Knowledge/Skills/Abilities/Expectations<ul><li>
Knowledge of medications and their correct administration based on age of the patient and their clinical condition</li><li>
Basic computer knowledge</li><li>
Able to organize tasks, develop action plans, set priorities and function under stressful situations</li><li>
Ability to maintain a good working relationship both within the department and with other departments</li><li>
Approximate percent of time required to travel: 0%</li><li>
Must read, write and speak fluent English</li><li>
Must have good and regular attendance</li><li>
Performs other related duties as assigned</li></ul>
Salary Range: $42.80 - $53.22/Hour
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. 
Qualifications 
Education<ul><li>
Graduation from an accredited Bachelor of Science in Nursing</li><li>
Associate Degree in Nursing or Nursing Diploma program</li></ul>
Licenses/Certification<ul><li>
Current state licensure as Registered Nurse</li><li>
BCLS certification required</li><li>
ACLS certifications preferred</li></ul>
Experience<ul><li>
Minimum six months&rsquo; Medical/Surgical experience in an acute care setting preferred</li></ul></div>

Registered Nurse Part Time Nights

<div>Description 
At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary<ul><li>
Maintains the stock room and is responsible for the receipt and distribution of supplies</li></ul>
Essential Functions<ul><li>
Assists with supply check-in and verify against purchase order</li><li>
Forwards purchase orders and packing slips to Accounts Payable</li><li>
Distributes supplies to appropriate location</li><li>
Maintains a cost requisition system</li><li>
Assures that the stock room is clean, safe and orderly</li><li>
Obtains data on chargeable supplies used by each patient and transfer the information into the computer system for billing</li><li>
Assists with physical inventory</li><li>
Conducts job responsibilities in accordance with the standards set out in the Company's Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards</li></ul>
Knowledge/Skills/Abilities/Expectations<ul><li>
Ability to maintain confidentiality of all patient and/or employee information to assure patient and/or employee rights are protected</li><li>
Understands the principles of growth and development for the entire lifespan and ability to provide care appropriate for adult and geriatric patients as appropriate to the patient population</li><li>
Ability to communicate in English effectively through verbal and written means to the extent necessary to perform job duties appropriately. Reading and comprehension at level necessary to perform job duties appropriately</li><li>
Ability to work under stress and to respond quickly in emergency situations. Ability to work cooperatively as a member of a team</li><li>
Demonstrates good interpersonal skills when working or interacting with patients, their families and other staff members</li></ul>
Salary Range: $20.00 - $23.91/Hour
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. 
Qualifications 
Education<ul><li>
High School graduate or equivalent</li></ul>
Licenses/Certification<ul><li>
None</li></ul>
Experience<ul><li>
None</li></ul></div>

Materials Management Clerk

<div>Description 
At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
SIGN ON BONUS $8,000.00 WITH A ONE YEAR COMMITTMENT.
Job Summary<ul><li>
Under direct supervision of Registered Nurse, provides nursing care within the scope of licensure for assigned patients according to established nursing standards and hospital policies and procedures.</li></ul>
Essential Functions<ul><li>
Under direct supervision of a Registered Nurse administers medication, performs treatments and patient care responsibilities as prescribed</li><li>
Consults with and keeps Registered Nurse informed of activities, symptoms, reactions, and changes in the patient&rsquo;s condition with regard to assigned patients</li><li>
Provides appropriate pain management techniques and educates the patient and family regarding pain management</li><li>
Administers medication following the five rights of medication administration within scope of practice</li><li>
Assists with the rehabilitation and treatment of patients in accordance with the medical plan of care, updates, and revises plan of care under the supervision of Registered Nurse</li><li>
Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills as directed by the Registered Nurse.</li><li>
Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families</li><li>
Interacts professionally with patient/family and involves patient/family in the formation of the plan of care</li><li>
Identifies and addresses psychosocial needs of patients and family; communicates with Social Services/Discharge Planner regarding both in-hospital and post discharge needs</li><li>
Interprets data about the patient&rsquo;s status in order to identify each patient&rsquo;s age specific needs and provide care needed by the patient group</li><li>
Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors</li></ul>
Knowledge/Skills/Abilities/Expectations<ul><li>
Knowledge of medications and their correct administration based on age of the patient and their clinical condition</li><li>
Basic computer knowledge</li><li>
Able to organized tasks, develop action plans, set priorities and function under stressful situations</li><li>
Ability to maintain a good working relationship both within the department and with other departments</li><li>
Must have good and regular attendance</li><li>
Must read, write and speak fluent English</li><li>
Approximate percent of time required to travel: 0%</li><li>
Performs other related duties as assigned</li></ul>
Salary Range: $28.08 - $34.91/Hour
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. 
Qualifications 
Education<ul><li>
Graduate of an accredited program for licensed vocational/practical nurses</li></ul>
Licenses/Certifications<ul><li>
Licensed Practical/Vocational Nurse License</li><li>
BLS Certification required</li><li>
Intravenous Therapy and Blood Certifications preferred</li><li>
ACLS may be required in certain care areas</li></ul>
Experience<ul><li>
Minimum six months&rsquo; prior experience in an acute care setting preferred</li></ul></div>

Licensed Vocation Nurse- Full Time-Days- W. Covina, CA

<div>Description 
At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.
Job Summary<ul><li>
Directs and coordinates functions and activities of nursing department and assigned clinical operation departments. Consults with and advises Administration on the general operation of the hospital. Develops nursing and clinical department&rsquo;s goals, objectives, standards of performance, policies and procedures. Organizes nursing and clinical departments according to administrative and nursing service guidelines; ensures compliance with legal, organizational, and medical staff standards. Has authority and responsibility for establishing, directing, and implementing the Standards of Nursing Practice and the clinical operations and financial matters related to all nursing and clinical care areas and functions. In a Network Market receives direction from and has a staff reporting relationship with the Network Market Sr CCO/CCO.</li></ul>
Essential Functions<ul><li>
Manages multiple subordinate department managers who supervise staff members in multiple departments that may include, but is not limited to: Nursing, Quality Management, Social Services, Laboratory, Respiratory Therapy, Radiology, and Case Management. Responsible for the overall direction, coordination and evaluation of the subordinate units/departments. Evaluates the results of overall operations regularly and systematically and reports these results to the Administrator.</li><li>
Maintains a sound plan of corporate organization establishing policies to insure adequate management development and to provide for capable management succession. Develops and installs procedures and controls to promote communication and adequate information flow. Establishes operating policies consistent with the Administrator&rsquo;s broad policies and objectives and ensures their execution.</li><li>
Ensures that the responsibilities, authorities, and accountability of all direct subordinates are defined and understood. Maintains an environment of collaboration and cooperation among hospital departments. May assume the administrative responsibilities of the Administrator in his/her absence.</li><li>
Promotes staff development by establishing a professional environment that supports accountability and autonomy. Shares knowledge and skills with nursing staff, students, colleagues, and others and acts as a role model and mentor.</li><li>
Leads nurse recruitment and retention efforts by planning and implementing new and creative initiatives to both attract and retain nurses and other key employees. Directs the interview and selection process for new nursing staff.</li><li>
Provides leadership in human resource development and management. Provides guidance and counsel to nursing leadership and staff. Maintains confidentiality of employee information to assure employee rights are protected. Provides adequate communication mechanisms within all departments and disciplines.</li><li>
Adheres to and promotes Equal Employment Opportunities and the facility's Affirmative Action Plan. Demonstrates ability to fairly and consistently apply the disciplinary process.</li><li>
Contributes to and/or leads the appropriate initiatives outlined in the Strategic Quality Plan. Serves on the Hospital Quality Council. Understands and supports the organization&rsquo;s continuous quality initiatives. Represents nursing services on various corporate, hospital and medical staff committees/meetings.</li><li>
Maintains a system which verifies licensure/certification, qualifications, experience and competency of each member of the nursing department and evaluates each member on a timely basis. Develops a strong working knowledge of the electronic medical record.</li><li>
Reviews and monitors work schedules assignments and patient classification daily to assess the appropriate number and skill level of personnel required to meet patient needs and develops appropriate staffing plans. Develops and implements policies and procedures and provides resources for maintaining patient safety and compliance with state/governmental regulations pertaining to nursing services and to the hospital</li><li>
Assures compliance with all regulatory and accreditation requirements</li><li>
Maintains survey readiness at all times. Participates in and coordinates survey preparation. Develops, implements, and monitors corrective action plans as needed. Conducts job responsibilities in accordance with the standards set out in the Company&rsquo;s Code of Business Conduct, its policies and procedures, the Corporate Compliance Agreement, applicable federal and state laws, and applicable professional standards</li><li>
Develops a positive image and relationship in the community and serves as a visible advocate for the hospital in working with area nursing programs, other healthcare institutions and community organizations. Collaborates with medical staff and other departments in planning and organizing the implementation of clinical services and programs as appropriate</li><li>
Continually strives to achieve ongoing professional growth and maintains personal competency</li><li>
Collaborates with hospital leadership in the preparation of a budget and the development of a capital expenditure plan for the nursing department</li><li>
Responsible for cost controls to insure maximum effectiveness of funds expended from approved departmental budgets</li><li>
Assures fiscal resource allocation to support current and potential nursing objectives and initiatives to optimize the provision of quality, cost effective care</li><li>
Responds appropriately to budget variances, including determining justifications and/or developing corrective measures</li><li>
Participates with hospital leaders, governing board, medical staff and clinical staff in developing the hospital&rsquo;s mission, strategic plans, budgets, resource allocation, operational plans and policies</li><li>
Develops, implements, and improves the care delivery model by assessing quality and efficiency and leading appropriate change that meets or exceeds customer expectations. Serves as an active member of the senior leadership team of the hospital interacting with the medical executive staff, governing board and other groups as appropriate</li><li>
Establishes credibility with patients, physicians, staff, and colleagues through the continuation of excellent patient care and the enhancement of clinical competencies across the organization as appropriate</li><li>
Acts as an advocate for patients and families</li><li>
Networks with state, regional and national peers and colleagues to share ideas and conduct mutual problem solving</li><li>
Seeks experiences to advance one&rsquo;s skills and knowledge base through such activities as education, certification, and participation in professional organizations</li></ul>
Knowledge/Skills/Abilities/Expectations<ul><li>
Excellent oral and written communication and interpersonal skills</li><li>
Basic computer skills with working knowledge of Microsoft Office, word-processing and spreadsheet software</li><li>
Knowledge of accreditation standards and compliance requirements</li><li>
Ability to demonstrate critical thinking, appropriate prioritization and time management skills</li><li>
Ability to work under stress and to respond quickly in emergency situations</li><li>
Ability to direct the preparation of short term and long-range plans and budgets based on broad corporate goals and growth objectives</li><li>
Ability to effectively present written and verbal information to top management, medical staff, public groups and Governing Body</li><li>
Ability to read, analyze and interpret financial reports and contracts</li><li>
Ability to spend a limited amount of time on travel required</li><li>
Must read, write and speak fluent English</li><li>
Must have good and regular attendance</li><li>
Performs other related duties as assigned</li></ul>
Salary Range: $99,000 - $149,000
ScionHealth has a comprehensive benefits package for benefit-eligible employees that includes Medical, Dental, Vision, 401(k), FSA/HSA, Life Insurance, Paid Time Off, and Wellness. 
Qualifications 
Education<ul><li>
Bachelor's degree in healthcare administration, business administration, finance, or clinical specialty</li><li>
Equivalent combination of education, training, and experience may substitute for education requirements</li></ul>
Licenses/Certifications<ul><li>
Registered Nurse in the state</li><li>
Current ACLS and BLS required</li></ul>
Experience<ul><li>
Minimum of three years&rsquo; experience in healthcare administration/management</li><li>
Minimum of three years&rsquo; experience in hospital management in an inpatient, acute care environment</li><li>
Graduate level education may substitute on a year-to-year basis for the required experience</li></ul></div>

Director of Nursing Full Time