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Company

University HealthCare Alliance
Address , Newark, 94560, Ca
Employment type FULL_TIME
Salary $49.59 - $65.71 an hour
Expires 2023-06-25
Posted at 1 year ago
Job Description
If you're ready to be part of our legacy of hope and innovation, we encourage you to take the first step and explore our current job openings. Your best is waiting to be discovered.

Day - 08 Hour (United States of America)
This is a Stanford Health Care - University Healthcare Alliance job.
A Brief Overview
Proactively manage inpatient and/or skilled nursing utilization to assure that medical care is appropriate, efficient, and medically necessary. Support facility discharge planning efforts, transfers and coordination of care.
Locations
Stanford Health Care - University Healthcare Alliance
What you will do
  • All other duties as assigned including department-specific functions and responsibilities:
  • Proactively and collaboratively interface with HMOs, physicians, internal staff, members and their families to assist in expediting appropriate discharge, including related bedside visits and post-discharge calls to members. Persuade hospital staff and physicians to adopt appropriate behavior to facilitate efficient and effective inpatient utilization while supporting a positive work environment and fostering teamwork.
  • Administration & Compliance:
  • Properly request letters, including applying the appropriate legal and regulatory requirements for ICE and health plan specific letter Templates.
  • Adheres to safety, P4P’s (if applicable), HIPAA and compliance policies.
  • Performs other duties as assigned and participates in organization projects as assigned.
  • Conduct concurrent review of inpatient utilization at assigned facilities according to clinical criteria, and diligently complete retrospective review within specific time frames. Support proactive facility discharge planning, transfers, and redirection while identifying barriers to efficient hospital utilization and facilitate resolution. Reduce avoidable bed days use by applying applicable criteria and properly documenting decisions and issuing related correspondence.
  • Inpatient Utilization Management:
  • Abide by and maintain telecommuting standards and adhere to the policy and procedures of assigned hospital(s). Also, meet CCR attendance and availability standards.
  • Serve as a liaison between the hospital, health plan, vendors, and providers while managing individual market to determine opportunities to improve utilization, quality of care, access issues and physician profiling. Build and maintain appropriate relationships on behalf of AMS.
  • Meet departmental review and documentation standards for work assignments while supporting AMS (Affinity Medical Group) authorizations process, clinical initiatives, and other activities.
  • Refer members to various other departments (i.e., Case Management, Disease Management, TPL, COB) for follow-up as appropriate.

Experience Qualifications
  • Three (3) years of Medical/Surgical clinical nursing experience.

Required Knowledge, Skills and Abilities
  • Proficient in Microsoft Office applications and other computer skills.
  • Ability to learn quickly and retain complex information.
  • Flexible and adaptable to change.
  • Ability to work effectively and collaboratively with a variety of customers including physicians, health plans, hospital/office staff, providers, and members.
  • Ability to travel to work assignments.
  • Excellent communication, organizational and time management skills with the ability to meet tight timeframes.
  • Physically capable to go onsite and work in hospital environment, requiring lengthy walking, standing and carrying medical records.
  • Ability to work independently and apply critical thinking skills towards making appropriate decisions.

Licenses and Certifications
  • Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure or
  • CADL - California Drivers License - Valid And In State
  • LVN - Licensed Voc Nurse and

Physical Demands and Work Conditions
Physical Demands
  • Constant Vision (Color, Peripheral, Distance, Focus).
  • Constant Hand Use.
  • Constant Standing.
  • Occasional Reaching (above shoulder level).
  • Frequent Twisting and Turning (Neck and Waist).
  • Frequent Pushing and Pulling.
  • Occasional Kneeling.
  • Occasional Sitting.
  • Occasional Fine Manipulation.
  • Occasional Climbing.
  • Frequent Repetitive Motion Hand Use.
  • Seldom Crawling.
  • Constant Walking.
  • Constant Bending.
  • Frequent Squatting.
  • Frequent Grasping.
Lifting
  • Occasional lifting of 31 - 40 lbs.
  • Frequent lifting of 0 - 10 lbs.
  • Seldom lifting of 40+ lbs.
  • Occasional lifting of 11 - 20 lbs.
  • Occasional lifting of 21 - 30 lbs.

Carrying
  • Occasional lifting of 21 - 30 lbs.
  • Seldom lifting of 40+ lbs.
  • Occasional lifting of 11 - 20 lbs.
  • Frequent lifting of 0 - 10 lbs.
  • Occasional lifting of 31 - 40 lbs.

Working Environment
  • Seldom Exposure to dust, gas, fumes or chemicals.
  • Seldom Driving cars, trucks, forklifts and other equipment.
  • Constant Working with biohazards such as blood borne pathogens, hospital waste, etc..
  • Seldom Walking on uneven ground.
  • Seldom Exposure to extremes in temperature, humidity or wetness.
  • Constant Working around equipment and machinery.
  • Frequent Use of respirator.
  • Seldom Exposure to excessive noise.
  • Seldom Working at heights.
  • Seldom Use of special visual or auditory protective equipment.
  • Frequent Operation of foot controls or repetitive foot movement.
Blood Borne Pathogens
  • Category I - Tasks that involve exposure to blood, body fluids, or tissues
Travel Requirements
  • 20% travel:

These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:
  • Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
  • Know Me: Anticipate my needs and status to deliver effective care
  • Coordinate for Me: Own the complexity of my care through coordination
Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
Base Pay Scale: Generally starting at $49.59 - $65.71 per hour
The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.