Qureos Mentor

University of Pennsylvania Health System

<div>Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. 
 
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? 
Summary: 
<ul><li>
Monitors appropriate use of internal resources, communication with interdisciplinary care team and Physician Advisor, with timely coordination of home care, DME, placements, hospice, community resources, transportation, and quality data collection and risk management referral.</li></ul>
Responsibilities: 
<ul><li>
Utilization management activities: monitor appropriate use of internal resources, communication with interdisciplinary care team and Physician Advisor</li><li>
Discharge planning activities: timely coordination of home care, DME, placements, hospice, community resources, transportation</li><li>
Quality data collection and risk management referral</li><li>
Works with patient and family to assure provision of choice in post hospital setting</li><li>
Educates patient / customers regarding scope and limitations of health care / insurance benefits</li><li>
Respects each patient&rsquo;s / customer&rsquo;s personal dignity, right to privacy and confidentiality</li><li>
Communicates expected discharge time frame</li><li>
Keeps current with new providers, new technologies and treatment modalities, and new resources using internet and other sources</li><li>
Recognizes and provides care based on the unique chronological issues and needs of the older adult.</li><li>
Interacts with the patient and family in a developmentally appropriate manner.</li></ul> 
Discharge Planning: 
<ul><li>
Completes timely and detailed assessment of patient and family social, emotional and/or discharge needs and health care benefits</li><li>
Develops and facilitates specific plan to address problems and/or concerns identified by patients, families and health care team</li><li>
Identifies and consistently documents delays; elevates issues appropriately</li><li>
Effectively communicates discharge plan with patients, families and health care team</li><li>
Documents ongoing assessments and plan of care in patient record (Canopy)</li><li>
Successfully assists patient in moving to the next level of care with transfers to home, agencies, and facilities and with referral to appropriate community resources</li><li>
Participates and drives accountability in daily interdisciplinary meetings</li></ul> 
Utilization Management: 
<ul><li>
Adheres to guidelines to satisfy 3rd party payer requirements</li><li>
Educates team in appropriate documentation to reflect Intensity of service (IS) / Severity of Illness (SI) and plan of care</li><li>
Proactively addresses level of care issues to ensure appropriate care settings and timely patient flow; elevates issues appropriately</li><li>
Enters all review activity in Canopy concurrently</li><li>
Accounts for all patient days accurately in Canopy</li><li>
Enters review indicating &ldquo;pending&rdquo; status of case if outcome not determined and accounts for all cases assigned on a daily basis</li><li>
Collects and submits data as indicated</li><li>
Completes readmission screen as indicated</li></ul> 
Quality Improvement and Risk Management: 
<ul><li>
Collects and submits data as indicated</li><li>
Communicates with service line / clinical effectiveness team members</li><li>
Identifies and appropriately communicates risk management issues</li><li>
Works with department leadership to develop and implement solutions to issues identified by the Case Management and Social Work Department</li></ul> 
New Technology / Computer Systems: 
Keeps current with new systems (MedView, On Base, SafetyNet, Sunrise, etc.) 
Incorporates technology into daily assignment (Outlook, Canopy, CERME, ECIN, shared drive, Internet)
Credentials: 
<ul><li>
Registered Nurse Licensure - PA (Required)</li></ul>
Education or Equivalent Experience: 
<ul><li>
Bachelor of Arts or Science (Required)</li><li>
Bachelor's degree in nursing (Required)</li><li>
2+ years Clinical Experience (Preferred)</li></ul>
We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives. 
 
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.</div>

PRN Discharge Planning RN Case Manager - Penn Presbyterian

<div>Description
Penn Medicine is dedicated to our tripartite mission of providing the highest level of care to patients, conducting innovative research, and educating future leaders in the field of medicine. Working for this leading academic medical center means collaboration with top clinical, technical and business professionals across all disciplines. 
 
Today at Penn Medicine, someone will make a breakthrough. Someone will heal a heart, deliver hopeful news, and give comfort and reassurance. Our employees shape our future each day. Are you living your life's work? 
The Physician Advisor is a key member of the healthcare organization's leadership team and is charged with meeting the organization's goals and objectives for assuring the effective and efficient utilization of health care services. The Physician Advisor is a physician serving the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor shall possess and/or develop expertise on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, denial management, compliance with governmental and private payer regulations, and appropriate physician documentation requirements.
Reporting directly to the Chief Financial Officer, the Physician Advisor works closely with medical staff leadership, medical staff, and all areas of resource management, case management, social services, discharge planning, and utilization management to develop and implement methods to optimize use of hospital services.
Responsibilities:
<ul><li>Make recommendations on level of care including initial level of care, secondary review, and as requested by case management</li></ul>
<ul><li>Review for daily level of care recommendations on cases placed in Observation</li></ul>
<ul><li>Participate in the denials management process</li></ul>
<ul><li>Be a leader in optimizing denial management</li></ul>
<ul><li>Perform peer to peer appeals and draft appeal letters for third party denials where appropriate</li></ul>
<ul><li>Apply the 2 midnight rule to Medicare reviews</li></ul>
<ul><li>Maintain compliance with Medicare rules as it applies to level of care recommendations</li></ul>
<ul><li>Stay current on changes in payer rules including CMS rules as it pertains to utilization review</li></ul>
<ul><li>Recommend and request additional and more complete medical record documentation from providers to support placement status or medical necessity</li></ul>
<ul><li>Understand and use InterQual and/or other appropriate criteria</li></ul>
<ul><li>Apply medical expertise to assist with appropriate billing for services</li></ul>
<ul><li>Provide feedback to Contracting on payer denial patterns where appropriate</li></ul>
<ul><li>Facilitate, mentor, and educate other physicians regarding documentation and payer requirements.</li></ul>
<ul><li>Facilitate, mentor, and educate case management on the utilization review process where appropriate</li></ul>
<ul><li>Chair, or assist the Lead Physician Advisor in chairing, the Utilization Committee</li></ul>
<ul><li>Performs duties in accordance with Penn Medicine and entity values, policies, and procedures</li></ul>
<ul><li>Other duties as assigned to support the unit, department, entity, and health system organization</li></ul>
Education/Experience:
<ul><li>MD or DO (required)</li></ul>
<ul><li>Minimum 5 years clinical experience in a hospital setting (required)</li></ul>
<ul><li>Possess or develop a solid foundation in the areas of utilization management and hospital operations (required)</li></ul>
<ul><li>Master of Business Administration (MBA), Master of Medical Management (MMM), or similar degree (preferred)</li></ul>
Certifications:
<ul><li>Possess and maintain an unrestricted medical license in the State of Pennsylvania (required)</li></ul>
<ul><li>American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) Health Care Quality and Management (HCQM) certification (preferred)</li><li>American College of Physician Advisors certification (ACPA-C) (preferred)We believe that the best care for our patients starts with the best care for our employees. Our employee benefits programs help our employees get healthy and stay healthy. We offer a comprehensive compensation and benefits program that includes one of the finest prepaid tuition assistance programs in the region. Penn Medicine employees are actively engaged and committed to our mission. Together we will continue to make medical advances that help people live longer, healthier lives.</li></ul> 
Live Your Life's Work
We are an Equal Opportunity employer. Candidates are considered for employment without regard to race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, familial status, genetic information, domestic or sexual violence victim status, citizenship status, military status, status as a protected veteran or any other status protected by applicable law.</div>

Penn Medicine Physician Advisor

Join University of Pennsylvania Health System 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.

University of Pennsylvania Health System

ABOUT_COMPANY

PRN Discharge Planning RN Case Manager - Penn Presbyterian

Penn Medicine Physician Advisor