Job Details Performs basic nursing skills, study coordination and data management, with a central focus on managing subject recruitment and enrollment, consistency of study implementation, data management and integrity, and compliance with regulatory requirements and reporting
Summary Performs basic nursing skills, study coordination and data management, with a central focus on managing subject recruitment and enrollment, consistency of study implementation, data management and integrity, and compliance with regulatory requirements and reporting Job Duties Collects and documents clinical information (data) from study participants. Provides patient education regarding research study. Obtains informed consent and supports enrollment into clinical trials.
Interacts with consortium members, organizes meetings and communicates with participating institutions, tracks and records progress, schedules meetings, records and distributes minutes.
Associate’s Degree Nursing Diploma or Associate’s Degree in Nursing. Bachelor’s Degree Nursing 1 year Minimum of 1 year of RN Clinical Experience in health care setting. 3 years case management experience, discharge planning or utilization management experience required. Knowledge of managed care, governmental and third party payors reimbursement.
Must be proficient with InterQual and mcg criteria and its application. Strong interpersonal relationships. Ability to: prioritize workload; collaborate with others to meet multiple deadlines; communicate effectively orally and in writing; work in a team environment, document in electronic health records.
Knowledge of the medical, social, economic, and other services provided by other departments or facilities, and the ability to integrate these multidisciplinary treatments for optimal patient care. Knowledge and understanding of legislation and regulatory bodies affecting healthcare practices. Knowledge of the techniques and the ability to work with a variety of individuals and groups in a constructive and collaborative manner.
Ability to manage multiple concurrent objectives, projects, groups, or activities, making effective judgments as to prioritizing and time allocation. Refers cases to the Physician Advisor per department procedures which require further review or clarification. Applies specific relevant medical necessity criteria for all patients within 24 hours of admission to determine the appropriate patient status.
Completes retrospective clinical review for cases requiring third party payor medical necessity approval for payment. Documents appropriate medical necessity criteria level of care guidelines subset. Evaluates Level I medical necessity appeal results to determine appropriateness of Level II appeal.
Refers case to Physician Advisor for input as needed. Evaluates contract auditor retrospective denials for appropriateness of appeal. Follows departmental procedures for Condition 44 downgrades, including medical record documentation, and informing patient and Case Manager.
Performs the appeal process and procedures for cases identified for IRO appeal. Performs appeal process in coordination with specific third party payor format and protocols. Refers cases without documentation of acute level of care to the Physician Advisor.
Researches clinical aspects of case as necessary to provide information necessary for appeal. Tracks and maintains list of Medicare admission requiring reviews. Documents in the patient’s medical record and work queues per department policies and procedures.
Identifies consistent issues related to denial and appeal activities and reports them to the Manager. Adheres to organizational policies and procedures, identified third party payer contract utilization management workflows and governmental payer processes. Case Management Safety Competencies: Identified patients using the appropriate patient identifiers.
Utilizes interdisciplinary collaborative team approach to patient care planning and discharge coordination. Ensures patient medical information is properly communicated to external providers/facilities. Communications discharge plan to patient, family and members of multidisciplinary team.
Ensures information is transferred to external providers/facilities. Understands the impact of developmental stage on adjustment to illness/trauma. Demonstrates ability to identify adolescent behaviors concerning body image, independence, sexual identity, interference with ability to establish identity, tendency to deny or minimize severity of illness.
Allows adult patient to maintain control and involves family in decision-making. Continually considers physical, social and emotional barriers and physical limitations while working with the geriatric patient. Demonstrates understanding of end of life issues. assesses and anticipates discharge planning needs to ensure a safe and effective transition to the next level of care for the patient (home, rehab or skilled facility).
Involves family/patient/guardian in the decision-making process related to discharge planning. Exhibits effective communication skills while working with neonate, infant, adolescent, and geriatric patient. Demonstrates ability to recognize the signs of physical and/or emotional abuse or neglect to help identify victims.
Follows appropriate policy and procedures for reporting of abuse. Demonstrates the ability to identify hearing and sight deficiencies in geriatric population. RN - Licensed Registered Nurse_PA - State of Pennsylvania
Bachelor’s Degree BSN Preferred. Less than 1 year of research experience preferred. Certification in InterQual criteria Additional Qualifications May collect and process specimen tissue to be analyzed by technical personnelWorks in collaboration with research team, and participates in identification, development, implementation and evaluation of specific goals and objectives.
Supports administration in the adherence to protocol guidelines. Collects and assists in organizing data for the research team. Physical Demands Lift and carry 40-50 lbs.
Examples: Push/pull patients on bed, stretcher (requires 29 lbs. push force), lateral transfers up to 50 lbs. of the patient's weight. Frequent to continuous standing/walking. Patient transporters can walk 8-10 miles per shift. *Patient care providers may be required to perform activities specific to their role including kneeling, bending, squatting and performing CPR.
Disclaimer: This position description provides the major duties/responsibilities, requirements and working conditions for the position. It is intended to be an accurate reflection of the current position, however management reserves the right to revise or change as necessary to meet organizational needs. Other responsibilities may be assigned when circumstances require.
Work Shift Rotating Worker Sub Type Regular Employee Entity Thomas Jefferson University Primary Location Address 132 S 10th Street, Philadelphia, Pennsylvania, United States of America Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value.
Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University , home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students.
Jefferson Health , nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.
Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status. Benefits Jefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts.
Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps ), have access to medical (including prescription) insurance. For more benefits information, please click here