Providence St. Joseph Health

Description:

Providence is calling a RN Inpatient Rehabilitation Facility Admissions/PPS Coordinator to Providence Medford Medical Center in Medford, OR. The schedule offered is Monday-Friday, 4, 8 hour days from 8am-4:30pm.

Apply today! Applicants that meet qualifications will receive a text message with some additional questions from our Modern Hire system.

We are seeking a RN Inpatient Rehabilitation Facility Admissions/PPS Coordinator that will be responsible for coordinating and facilitating access to inpatient rehabilitation services. This position is accountable for monitoring of appropriate utilization of unit services in accordance with current Center for Medicare/Medicaid Services (CMS) guidelines and regulations.

Under the direction of the Medical Director the Admissions Coordinator evaluates internal and external referrals for admission per the criteria established by CMS and coordinates and facilitates admission including obtaining of insurance authorization and completing UR functions.

Upholds the standards of confidentiality, attendance and punctuality.

In this position you will have the following responsibilities:

• Patient Assessment:

• Responsible for gathering, evaluating, and organizing patient demographic and clinical data for determination of appropriateness for admission to inpatient rehabilitation care

• Reviews information with the Medical Director and/or unit management to determine appropriateness of the admission, to identify candidates who meet criteria and who will benefit from program services

• Be responsible for ensuring that required documentation (pre-admission screening assessments, post-admission physician evaluations, etc.) are completed timely, and signed / authorized by a rehabilitation physician within required time frames

• Coordinate with IRF PPS Coordinator in identifying and communicating allowable comorbidities and expected length of stay to rehabilitation team

• Be able to identify expected costs, and Medicare and insurance reimbursement

• Care Planning:

• Participate as an active member in weekly team conferences

• Collect, organize, and communicate evaluation findings to the rehab team in order to facilitate the initiation of the plan of care

• In collaboration with the team, works towards effective management of program length of stay, resource utilization, and identifies and communicates plans for discharge disposition from the time of admit

• Clinical / Financial:

• Assess insurance benefits and obtains authorization if needed for admission to the inpatient rehab unit, and perform ongoing utilization review as required during the stay

• Verify eligibility, coverage, deductibles, limitation, exclusions, and payments with primary and secondary payers

• Negotiate approval for a client's stay. If necessary, negotiates rates with payers

• Document information and communication with payer, patient and family concerning estimated LOS, discharge planning, follow-up care recommendations and insurance coverage

• Communicate with the team to ensure clinical and financial outcomes are met within an appropriate length of stay, with the effective use of resources and within established quality standards

• Monitor that patients meet criteria for continued stay: daily review of severity of illness, nursing and medical acuity, and intensity of care (3 hours of therapy per day)

• Function as a liaison to the payer, Medicare, Medicaid, other payers, to negotiate and manage the financial resources and to ensure effective communication regarding the patient's treatment

• Contact the payer both verbally and in writing, regarding the patient's initial assessment, progress and outcomes as requested

• Maintain records (computer-generated and paper) as defined by hospital policies and procedures

• Document any special handling instructions and/or data noted by the payer in the patient's medical record 100% of the time, as well as informs the inter-disciplinary rehab team, patient and family

• Quality & Analysis:

• Monitor and report unit compliance with 60% rule

• Perform all aspects of utilization review for patient caseload, and helps manage appeal of denials

• Complete analysis of expected and actual payment received and investigates billing discrepancies

• Obtain and report outcome data

• Participate in shared governance, collectively working toward a common goal, through clinical practice, education, research, performance improvement, professional and satisfaction activities

• Educator:

• Maintain current knowledge of CMS guidelines, rules, and regulations related to inpatient rehabilitation criteria and reimbursement

• Summarize changes and disseminates information to the Manager, Medical Director, and staff as appropriate

• Function as a preceptor for new Coordinators, and is a mentor for staff and students

• Interact and contribute to the professional environment and professional development of peers and health care providers

• Collaborate with the patient, family, and members of the healthcare team

• Autonomy:

• Expected to practice autonomously consistent with professional standards, Self-starter; meet deadlines, manage time effectively

• Evaluate own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations

• Maintain knowledge and competency that reflects current nursing practice. Bound by the American Nurses' Association Code of Ethics for nurses and integrates ethical provision in all areas of practice

• Demonstrate leadership and participation in hospital/program/nursing committees, and conferences, or other professional activities

• Participate as a team leader in unit surveys

• Marketing:

• As directed by manager and or Medical Director represents PARC at other PHS facilities, and at community education or marketing events

• Maintain a thorough knowledge of facilities, products, services, and acuity trends

• Develop relationships with referral sources

• Conduct other duties including exhibiting and providing tours

• Promote good public relations with patients, healthcare providers, and other involved people

• Educate clients, family members or significant others, referral sources, hospital personnel, external payers, and external case managers as to rehabilitation program benefits and services

• Market and/or networks with payers, referrals, and other health care agencies no less often than quarterly

• Develop rapport with clients and their family members or significant others

• Exhibit professional behavior as a facility representative Providence is calling a RN Inpatient Rehabilitation Facility Admissions/PPS Coordinator - Inpatient Rehabilitation (0.0 FTE, Days) to Providence Medford Medical Center in Medford, OR We are seeking a RN Inpatient Rehabilitation Facility Admissions/PPS Coordinator - Inpatient Rehabilitation that will be responsible for coordinating and facilitating access to inpatient rehabilitation services. This position is accountable for monitoring of appropriate utilization of unit services in accordance with current Center for Medicare/Medicaid Services (CMS) guidelines and regulations.Under the direction of the Medical Director the Admissions Coordinator evaluates internal and external referrals for admission per the criteria established by CMS and coordinates and facilitates admission including obtaining of insurance authorization and completing UR functions.Upholds the standards of confidentiality, attendance and punctuality. In this position you will have the following responsibilities:

• Patient Assessment:

• Responsible for gathering, evaluating, and organizing patient demographic and clinical data for determination of appropriateness for admission to inpatient rehabilitation care

• Reviews information with the Medical Director and/or unit management to determine appropriateness of the admission, to identify candidates who meet criteria and who will benefit from program services

• Be responsible for ensuring that required documentation (pre-admission screening assessments, post-admission physician evaluations, etc.) are completed timely, and signed / authorized by a rehabilitation physician within required time frames

• Coordinate with IRF PPS Coordinator in identifying and communicating allowable comorbidities and expected length of stay to rehabilitation team

• Be able to identify expected costs, and Medicare and insurance reimbursement

• Care Planning:

• Participate as an active member in weekly team conferences

• Collect, organize, and communicate evaluation findings to the rehab team in order to facilitate the initiation of the plan of care

• In collaboration with the team, works towards effective management of program length of stay, resource utilization, and identifies and communicates plans for discharge disposition from the time of admit

• Clinical / Financial:

• Assess insurance benefits and obtains authorization if needed for admission to the inpatient rehab unit, and perform ongoing utilization review as required during the stay

• Verify eligibility, coverage, deductibles, limitation, exclusions, and payments with primary and secondary payers

• Negotiate approval for a client's stay. If necessary, negotiates rates with payers

• Document information and communication with payer, patient and family concerning estimated LOS, discharge planning, follow-up care recommendations and insurance coverage

• Communicate with the team to ensure clinical and financial outcomes are met within an appropriate length of stay, with the effective use of resources and within established quality standards

• Monitor that patients meet criteria for continued stay: daily review of severity of illness, nursing and medical acuity, and intensity of care (3 hours of therapy per day)

• Function as a liaison to the payer, Medicare, Medicaid, other payers, to negotiate and manage the financial resources and to ensure effective communication regarding the patient's treatment

• Contact the payer both verbally and in writing, regarding the patient's initial assessment, progress and outcomes as requested

• Maintain records (computer-generated and paper) as defined by hospital policies and procedures

• Document any special handling instructions and/or data noted by the payer in the patient's medical record 100% of the time, as well as informs the inter-disciplinary rehab team, patient and family

• Quality & Analysis:

• Monitor and report unit compliance with 60% rule

• Perform all aspects of utilization review for patient caseload, and helps manage appeal of denials

• Complete analysis of expected and actual payment received and investigates billing discrepancies

• Obtain and report outcome data

• Participate in shared governance, collectively working toward a common goal, through clinical practice, education, research, performance improvement, professional and satisfaction activities

• Educator:

• Maintain current knowledge of CMS guidelines, rules, and regulations related to inpatient rehabilitation criteria and reimbursement

• Summarize changes and disseminates information to the Manager, Medical Director, and staff as appropriate

• Function as a preceptor for new Coordinators, and is a mentor for staff and students

• Interact and contribute to the professional environment and professional development of peers and health care providers

• Collaborate with the patient, family, and members of the healthcare team

• Autonomy:

• Expected to practice autonomously consistent with professional standards, Self-starter; meet deadlines, manage time effectively

• Evaluate own nursing practice in relation to professional practice standards and guidelines, relevant statutes, rules, and regulations

• Maintain knowledge and competency that reflects current nursing practice. Bound by the American Nurses' Association Code of Ethics for nurses and integrates ethical provision in all areas of practice

• Demonstrate leadership and participation in hospital/program/nursing committees, and conferences, or other professional activities

• Participate as a team leader in unit surveys

• Marketing:

• As directed by manager and or Medical Director represents PARC at other PHS facilities, and at community education or marketing events

• Maintain a thorough knowledge of facilities, products, services, and acuity trends

• Develop relationships with referral sources

• Conduct other duties including exhibiting and providing tours

• Promote good public relations with patients, healthcare providers, and other involved people

• Educate clients, family members or significant others, referral sources, hospital personnel, external payers, and external case managers as to rehabilitation program benefits and services

• Market and/or networks with payers, referrals, and other health care agencies no less often than quarterly

• Develop rapport with clients and their family members or significant others

• Exhibit professional behavior as a facility representative

Qualifications:

Required qualifications for this position includes:

• Associate's Degree in Nursing

• Current, unencumbered State of Oregon Registered Nurse license

• Current Basic Life Support (BLS) at time of hire

• One (1) year of experience in Inpatient Nursing

Preferred qualifications for this position includes:

• Bachelor's Degree in Nursing

• One (1) year of experience in Case Management

• One (1) year Inpatient rehabilitation experience

About Providence in Oregon

As the largest healthcare system and largest private employer in Oregon, Providence offers exceptional work environments and unparalleled career opportunities.

The Providence Experience begins each time our patients or their families have an encounter with a Providence team member and continues throughout their visit or stay. Whether you provide direct or indirect patient care, we want our patients to feel that they are in a welcoming place where they can be comfortable and free from anxiety. Our employees create the Providence Experience through simple, caring behaviors such as acknowledging and welcoming each visitor, introducing ourselves and Providence, addressing people by name, providing the duration of estimated wait times and updating frequently if timelines change, explaining situations in a way that puts patients at ease, carefully listening to their concerns, and always thanking people for trusting Providence for their healthcare needs. At Providence, our quality vision is simple,

"Providence will provide the best care and service to every person, every time."

Providence is consistently ranked among the top 100 companies to work for in Oregon. It is also home to two of our award-winning Magnet medical centers. Providence hospitals and clinics are located in numerous areas, ranging from the Columbia Gorge to the wine country to sunny southern Oregon to charming coastal communities to the urban setting of Portland. If you want a vibrant lifestyle while working with a team highly committed to the art of healing, choose from our many options in Oregon.

For information on our comprehensive range of benefits, visit:

http://www.providenceiscalling.jobs/rewards-benefits/

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Part-time

Shift: Day

Job Category: Patient Services

Location: Oregon-Medford

Req ID: 280608