Patient Service Agent (Specialty) - Mercy Fort Smith (Remote)

Patient Monitor Tech/CNA - Evening Shift

Advocate Health · Centralia, WA

Role Focus & Work Location: • The majority of this role is spent in a virtual patient monitoring environment, not at the bedside. Patient Monitor Tech/CNAs work from a business office near St. Luke's Medical Center, where they are responsible for remotely observing 8–12 patients simultaneously to help maintain safety and report concerns to the care team. • There is limited in-person responsibility, requiring occasional onsite shifts at St. Luke's Medical Center (approximately once every 6 weeks) as a patient sitter or CNA. Major Responsibilities: • Maintains visual and audio observation at all times. Verbally redirects patient over 2 way audio device in patient room. Immediately summon nursing staff if the patient requires physical assistance. • Provides floor staff with information in a timely fashion when patient poses a safety concern to themselves or others. Participates in collaborative identification and reporting of patient safety issues. Seeks assistance with removal of any potential safety hazards from room and reports findings to appropriate staff members. Monitors patient safety environment. • Demonstrates safe work practices and attitude, follows safety rules and guidelines, works to prevent unsafe conditions and behaviors, and participates in organizational and department safety programs. • Maintains patient dignity and privacy. • Participates in report with accountable staff coming into or leaving shift. Review pertinent information and behaviors. • Demonstrates understanding and proficiency of Avasure software. Demonstrates knowledge and skill necessary to provide appropriate observation of the patients enrolled in the Virtual Monitoring Program. Licensure, Registration, and/or Certification Required: • Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association (AHA) needs to be obtained within 45 days, and • Nurse Aide in good standing as indicated with the State Registry in which the team member practices. Education Required: • High School Graduate. Experience Required: • Typically requires 1 year of experience in patient care. Knowledge, Skills & Abilities Required: • Capable of continuous monitoring of up to 12 patients at one time, remaining alert and focused on patients at all times while on duty. • Ability to use discretion and courtesy when working with patients, visitors and staff. • Ability to communicate with hospital staff and respond quickly to patient behavioral changes. • Ability to prioritize simultaneous situations and be efficient in multitasking. • Ability to communicate effectively with patients using a headset and microphone. • Basic Microsoft windows and computer experience. Physical Requirements and Working Conditions: • Headset must be worn when on duty. • Must have functional vision and hearing. • Operates all equipment necessary to perform the job. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Utilization Review Nurse This position has a remote option for those living close and will be able to come into the hospital as needed. The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. Responsibilities: • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders. • The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary. • Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines. • Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination. • Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary's member's health care for behavioral health care management. • Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI). • Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines. • Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities. • Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up. • Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options. • Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate. • Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities. • Must be able to take after hour calls to meet business requirements as needed. Job Requirements: Education/Skills • Graduate of an accredited school of vocational nursing or equivalent required • Associate's (ADN) or Bachelor's (BSN) in Nursing preferred Experience • 3 – 5 years of nursing experience preferred • Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required • General computer knowledge and capability to use computers required Licenses, Registrations, or Certifications • LVN license in the state of employment or compact required • RN license in state of employment or compact preferred Work Schedule: 5 Days - 8 Hours Work Type: Full Time

Case Manager RN - Field

CVS Health · Centralia, WA

Case Manager RN We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. This is a full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more, in the Central region of WV. Field based travel locations may include member homes, residential treatment facilities, group homes, shelters, and detention facilities. Qualified candidates must reside in the region, in one of the following counties: Roane, Calhoun, Gilmer, Kanawha, Clay, Braxton, Fayette, Nicholas, or Webster. The Case Manager RN (CM RN) is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member's overall wellness. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness through integration. Services strategies policies and programs are comprised of network management and clinical coverage policies. This position is heavy community-based with some onsite presence at Department of Health and Human Resources (DHHR) offices. Schedule is Monday – Friday, 8am-5pm, standard business hours. No nights, weekends, or holidays. A flexible work schedule may be available after 6 months of service and with demonstrated performance and attendance. Fundamental Components: • Conducts face to face member visits • Using clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. • Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. • Assesses information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Reviews prior claims to address potential impact on current case management and eligibility. • Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. • Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. • Effective communication skills, both verbal and written. • Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Required Qualifications • Registered Nurse with current unrestricted West Virginia (WV) license or Registered Nurse with current unrestricted WV or "multi-state privilege" license • 5+ years' clinical practice experience • 2+ years' experience with personal computer, keyboard, mouse, multi-system navigation; and MS Office Suite applications (Outlook, Word, Excel, SharePoint, Teams) • Must possess reliable transportation and be willing and able to travel in the assigned region 50% or more, of the time. Mileage is reimbursed per our company expense reimbursement policy Preferred Qualifications • Medicaid experience. • Waiver experience • Foster care experience • Crisis intervention skills • Managed care/utilization review experience • Certified Case Manager (CCM) certification • Case management experience in an integrated model • Case management and discharge planning experience • Familiarity with QuickBase • BSN degree preferred Education Associate's degree in nursing or nursing diploma required Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $54,095.00 - $116,760.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments.

$13.07/hr

Customer Service/ Phone Intake Representative

Tryfacta · Centralia, WA

About US: Tryfacta is a leading, nationally renowned Workforce Management Solution provider for private &public sector firms across the US. We specialize in Healthcare, IT, Business Support, and Professional & Craft/Light Industrial ecosystems. Founded in March 1996, we have a presence in all 50 States. Tryfacta has Ranked number 1 as one of the fastest-growing companies by Inc. Magazine (Inc. 5000)! Tryfacta is certified by the Joint Commission for Healthcare Staffing Services & has numerous ISO Certifications that capture our commitment to continuous improvement. Job Summary: Tryfacta is seeking a Customer Service/ Phone Intake Representative for our client in Madison WI,53705. This is a temporary contract assignment. If you meet the qualifications listed below and are interested, please Apply Now! Position Title: Customer Service/ Phone Intake Representative Location: Madison WI, 53705 Duration: 4 Months Work Schedule: Monday through Friday 35/ hr week Pay rate: $13.07/hr Responsibilities for this position include, but are not limited to: • Answer incoming calls and make outbound calls. • Assist customers with their inquiries. • Communicate courteously with customers by telephone, e-mail, or letter. • Provide a high level of personalized customer service. • Take notes of conversations with customers. • Investigate and solve customer problems. • Update databases with changes to the details and status of each customer. • Use of a variety of computer applications and databases related to call center services and credentialing. • Arrange the distribution of information to managers and coworkers • Maintain respect and discretion. • Follow up inquiries as required via emails or call backs. • Keep accurate records of discussions or correspondence with customers. • Meet with others to discuss possible improvements to customer service. Tryfacta is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.