Qureos Mentor

Palm Medical Centers

<div>Palm Primary Care is a rapid growing company currently seeking an experienced Clinical Coordinator with leadership experience to join our team.
The Clinical Coordinator performs a variety of tasks and coordinates the plans of care for hospital and nursing home patients, from admission to discharge to ensure the continuation of care is provided effectively and efficiently.
Responsibilities include:<ul><li>
Admit new clients by reviewing records and applications; conduct orientations.</li><li>
Communicate the daily tracking of all hospital/nursing home admissions and discharge for both statistical and cost management purposes.</li><li>
Determine clients' requirements by completing intake interviews; Determine need for therapeutic medical, psycho-social, and psychiatric evaluations, review therapist evaluations, treatment objectives, and plans.</li><li>
Establish treatment programs by setting schedules and routines; coordinate services being provided; arrange resources- including transportation and escort.</li><li>
Monitor cases by verifying clients' attendance; observe and evaluate treatments and responses; advocate for needed services and entitlements; obtain additional resources; ability to intervene in moments of crises by providing personal support.</li><li>
Maintain clients' records by reviewing case notes, logging events and progress.</li><li>
Communicates with PPC managers on members discharged from inpatient facilities to assure appropriate medical care follow up</li><li>
Obtain weekly update on all nursing home patients</li><li>
Communicate potential catastrophic and stop loss patients</li><li>
Identify patients related to possible subrogation and/or cost allocations</li><li>
Coordinate the transfers of patients as instructed by the Medical Director or PCP.</li><li>
Arrange direct admissions to hospitals and placement in nursing homes</li><li>
Assist PCP in placing patients at SNF</li><li>
Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements</li><li>
Communicate clients' progress by conducting weekly interdisciplinary meetings and evaluations, disseminating results and obstacles to therapeutic team and family, identify treatment influences.</li><li>
Improve staff competence by providing educational resources; balancing work requirements with learning opportunities; evaluating the application of learning to changes in treatment results.</li><li>
Improve treatment results by studying, evaluating, and re-designing processes, implementing changes, rewriting policies and procedures.</li><li>
Improve financial status by analyzing results, monitoring variances, identifying trends, and recommending actions to management.</li></ul>
Requirements:<ul><li>
Proven working experience in case management, mental health care manager or a related job experience</li><li>
Excellent knowledge of case management principles, management and reimbursement</li><li>
Previous experience with psychological aspects of care</li><li>
Effective communication skills</li><li>
Excellent organizational and time management skills</li><li>
Familiarity with professional and technical emerging knowledge</li><li>
Problem solving skills and ability to multi-task</li><li>
Compassionate with teamwork skills</li><li>
Knowledge of terminology CPT codes and ICD 10</li><li>
Bilingual preferred</li><li>
Knowledge of InterQual or Milliman Care Guidelines preferred</li></ul>
Minimum Qualifications: Minimum 3 years of Clinical Coordinator experience.
Job Type: Full-time
Salary: negotiable based on experience
Benefits:<ul><li>
401(k)</li><li>
Dental insurance</li><li>
Employee assistance program</li><li>
Flexible spending account</li><li>
Health insurance</li><li>
Life insurance</li><li>
Paid time off</li><li>
Vision insurance</li></ul>
Schedule:<ul><li>
Day shift</li><li>
Monday to Friday</li></ul>
Experience:<ul><li>
Case management: 3 years (Required)</li></ul>
Work Location: Hybrid
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Clinical Coordinator / Case Manager

<div>Position Summary: 
The Concurrent Review Nurse is responsible for performing utilization management activities to ensure medical services are delivered effectively, efficiently, and appropriately. This includes reviewing inpatient admissions and ongoing hospital stays to determine medical necessity, appropriateness of care, and length of stay in accordance with clinical guidelines and payer requirements. 
 
Key Responsibilities:<ul><li>
Conduct timely and accurate concurrent reviews of inpatient hospitalizations and other levels of care.</li><li>
Evaluate clinical documentation against evidence-based criteria (e.g., InterQual&reg;, MCG) to determine medical necessity and appropriate level of care.</li><li>
Collaborate with physicians, hospital staff, and insurance companies to coordinate patient care and discharge planning.</li><li>
Communicate utilization review decisions and recommendations to providers and payers.</li><li>
Document all reviews, decisions, and communications in accordance with regulatory and organizational standards.</li><li>
Identify cases requiring escalation or peer review and follow established procedures.</li><li>
Ensure compliance with CMS guidelines, accreditation standards (e.g., NCQA, URAC), and HIPAA.</li><li>
Participate in quality improvement initiatives and departmental meetings</li></ul>
Qualifications: 
 
Education &amp; Licensure:<ul><li>
Registered Nurse (RN) license, active and in good standing, required.</li><li>
Associate or Bachelor&rsquo;s degree in nursing (BSN preferred).</li></ul>
Experience:<ul><li>
Minimum 2 years of clinical experience (e.g., med-surg, critical care).</li><li>
At least 1 year of utilization review, case management, or managed care experience preferred.</li></ul>
Skills &amp; Competencies:<ul><li>
Knowledge of InterQual&reg;, MCG, or other clinical review guidelines.</li><li>
Familiarity with Medicare/Medicaid and commercial insurance regulations.</li><li>
Strong analytical and clinical judgment skills.</li><li>
Effective communication and negotiation skills.</li><li>
Proficient with electronic medical records (EMRs) and utilization review platforms.</li><li>
Detail-oriented with excellent organizational skills.</li></ul>
Work Environment:<ul><li>
Remote</li></ul> 
Palm Primary Care is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws. 
 
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm Primary Care makes hiring decisions based solely on qualifications, merit, and business needs at the time.
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Concurrent Review Nurse

Join Palm Medical Centers 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.

Palm Medical Centers

About Company

Clinical Coordinator / Case Manager

Concurrent Review Nurse