We are looking for a Utilization Review Case Manager to join our collaborative team at Memorial Health! What You'll Do: Clinical/Technical Recognizes, interprets, documents, and communicates information necessary for quality patient care and related patient information. Always maintains confidentiality to protect patient’s privacy and maintains Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Carries out the hospital utilization review plan. Collaborates with the interdisciplinary team and asks clarifying questions regarding documentation, hospital course, and expected date of discharge. Provides clinical information to the payer as requested to obtain admission authorization and to support level of care. Communicates payer resources available for discharge planning to Case Management Team. Understands in-network coverage and out of network insurance coverage and impact on patients served. Communicates information to patient upon request. Coordinates with Patient Financial Services on all patients, including those without insurance coverage to obtain Hospital Care Assurance Program (HCAP) and Medicaid eligibility. Daily Responsibilities: Reviews charts for medical necessity and assists on the level of care and status determinations. Utilizes Evidenced Based Criteria Set (Interqual, Milliman, etc) to assess medical necessity, appropriateness of admission, level of care, length of stay, need for continued stay, and avoidable days or delays in patient care. Will provide suggestions to the ED provider and Admitting Hospitalist of the most appropriate admission status based on the patient’s expected length of stay, application of standard of care criteria, patient presentation and treatment plan of care. Will assist providers to clearly and completely document for the purpose of accurately representing the acuity of the patient. Formulates and documents clinical review and submits clinical information to payer as required per departmental policy. Has knowledge of expected length of stay based on established criteria, ensures payer response to authorization requests are obtained for hospital services and documents authorization in auth/cert fields in Epic based on payer responses. Accesses payer portals daily to submit clinical review, appeal letters and obtain authorization numbers. Documents activity in Epic UR comment and communication field. Utilizes physician advisor services in accordance with hospital/department policy for secondary review consideration. Collaborates with presurgical scheduler to monitor the surgery schedule daily for prior authorization of inpatient procedures and monitoring for Medicare FFS inpatient only procedure status confirmation. Assumes responsibility for the oversight of inpatient medical necessity denials: track, monitor, investigate, and report denials and outcomes through participation in the Denials Management Committee and per request investigate root cause analysis or other information. Appropriately document and generate timely appeal letters and submit to payers for denial reconsideration. Manage work queues as assigned by Director or Supervisor. Including tracking and tending results. Calls payer UR nurse and requests reconsideration of a potential concurrent denial via conversation with insurance UR nurse reviewer prior to accepting a concurrent denial. Generates timely and thorough appeal letters in response to an inpatient denial and submits via the payer requested methodology. Manage the workflow through the appropriate work queues and determines case review based on timeliness of the appeal and high dollar amount. Facilitates the Peer-to-Peer denial/appeal process and proactively communicate with payer for denials mitigation and prevention. Appropriately monitor the outcome and document the process in Epic. Provides written notices (following the documentation retention policy) to the Medicare Beneficiary, including but not limited to: Hospital-Issued Notice of Non-Coverage (HINN) Detailed Notice of Discharge Advance Beneficiary Notices Denial letters if applicable Coordinates with Livanta, Permideon (or other organizations) and medical team for patient denials and requests for additional information for inpatient stays. Follows policy/procedure maintaining regulatory compliance and documentation retention requirements. Maintains a current knowledge of rules and regulations surrounding utilization management; observation management, and payer methodologies including approvals, denials, and appeal processes. Maintains a current knowledge of revised rule/regulatory changes pertaining to utilization review, strategies to reduce and combat denials, and effective care transitions management. Collects and interprets data as designated by the Utilization Review Committee, Denials Committee, and the department Key Results Measures including, but not limited to outlier review, readmission analysis, observation management, extended stay reviews, denials root cause analysis, and other reporting as assigned. Acts as a resource for staff; including Providers, agency and contingent personnel. Interpersonal Communicates in order to educate patients/ family; provides kindness and consideration in meeting the emotional needs of patients; confers with Providers and Case Management Team, interacts with ancillary staff. Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity. Communicates and assists providers as indicated. Must have excellent written, verbal and telephone communication skills. All interactions are conducted in a professional manner. Demonstrates a positive attitude. Resolves conflict through one-on-one negotiation or with the assistance of Director or designee. Demonstrates the philosophy of team concept. Participates in unit projects, attends committees as assigned, and attends monthly staff meetings. Communicates dissatisfaction with issues to Director; actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers. Critical Thinking Actively looks for and creates opportunities to improve the department, staff, and personal development. Develops and demonstrates knowledge of current developments in field to maintain professional competency. Compliant with CMS, DNV, Federal, State, hospital and departmental policies and procedures. Follows the Ohio Nurse Practice Act Understand the importance of Utilization Review and how job functions, impacts the revenue cycle, compliance, patient finances, and patient satisfaction. Documentation Maintains accurate data collection and timely documentation. Documentation retention practices are followed per hospital and department policy. Refrains from using unaccepted abbreviation in written documentation. When necessary, follows department downtime procedures Maintains license Enters and retrieves information from computer; demonstrated competence in the electronic medical record, Microsoft/Outlook/Word/Excel, other software tools and portals as assigned. Unit Financial Accountability Understands and is accountable to hospital goals and benchmarks for financial viability Is accountable for productivity and time management Maintains appropriateness of supplies Education Completes all mandatory education and in services required for the facility Completes an initial orientation and competencies per Human Resources established guidelines Completes annual competencies and unit specific competencies per Human Resources established guidelines Maintains professional competency; actively contributes to the solution of problems; deals with problems involving several variables within familiar context Responsible and accountable for maintaining own state board required CEU’s per licensing board requirements. Has knowledge of HIPAA privacy regulation and related procedures Has knowledge of Centers for Medicare and Medicaid Services and third party in network payer updates on benefit coverage and acute care policies Reviews Case management literature as distributed by director or designee Maintains bi-annual BLS certification. Completes mandatory health requirements (e.g. annual TB testing, Fit testing and physicals as indicated.) Attendance Demonstrates regular and predictable attendance Work scheduled holidays and weekends Overtime to be pre-approved per Director Requested schedule time off to be pre-approved by Director or designee Other Exhibits behaviors reflective of Memorial’s core values: Compassion, Accountability, Respect, Excellence, and Service Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements. Employee performs within the prescribed limits of the hospital’s and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline. Works assigned shift hours, may be asked to rotate hours or shifts if needed or upon the Director's request/discretion, to maintain adequate department coverage including weekend and holiday rotation. Performs reviews as assigned across multiple access points into the hospital and manages both inpatient and outpatient care areas as they relate to the UR function. Performs other duties as assigned. Requirements Completion of an accredited school of nursing with current active registration in the State of Ohio as an RN or LPN in good standing. Must have at least two years of clinical nursing or case management experience. Completes the required 24 contact hours of approved CE during each two year renewal period consistent with the Ohio Board of Nursing requirements. Maintains continuous certification in American Heart Association’s BLS. Shift 1st (Includes every other weekend rotation) Hours 80 per pay (Every two weeks) Benefits • Medical Insurance • Dental Insurance • Vision Insurance • Life Insurance • Flexible Spending Account Time Off • Vacation • Sick Leave • 11 Paid Holidays • Personal Day Retirement • Ohio Public Employee Retirement System • Deferred Compensation Other • Tuition Reimbursement • Kidzlink Daycare Center • Employee Recognition • Free Parking • Wellness Center • Competitive Salaries • Community/Family Atmosphere We look forward to seeing your application! It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701.
We are looking for an LPN to join our Mill Valley Team! The current schedule for this position is 7 am- 4 pm Monday-Friday. What You'll Do: Clinical responsibilities: accompanying patients to exam/procedure room; assisting patients as needed with walking, performs injections, EKG’s, point of care testing on patients at the direction of a provider, dressing, collecting specimens, preparing for exam, etc.; collecting & documenting patient history; performing screenings per provider guidelines; assisting physician with various procedures; sterilization, instrument wrapping and autoclaving; checking vital signs; prescription verifications with physician’s orders; minor surgery assists including surgical tray set-up pre/post-surgical care, applying dressing, and suture removal; biohazard waste disposal and monitoring; laboratory procedures; quality control methods; capillary punctures and venipuncture; specimen handling; emergency triage and first aid, verify vaccine orders and insurance eligibility for patients utilizing the VaxCare system; Maintain appropriate daily workflow to ensure patients are seen in a timely fashion, facilitate after care and follow-up for patients at conclusion of appointments, etc. Patient care responsibilities: Effectively utilizes the electronic medical records system to check schedules, complete prior authorizations, and organize patient flow; demonstrates acceptable time management techniques; accurate charting; accurately relays instructions to patients/families; answers calls and provides pertinent information. Clerical responsibilities: includes sending/receiving patient medical records; obtaining lab/x-ray reports, hospital notes, referral information, etc.; completing forms/requisitions as needed; scheduling appointments (i.e., surgeries, procedures, etc.); verifying insurance coverage and patient demographics; managing and updating charts to ensure that information is complete and filed appropriately. Responsible for setting up instruments and equipment according to protocols; cleaning exam / procedure rooms, instruments and equipment between patient visits to maintain infection control; cleaning and sanitizing according to scheduled maintenance program and keeping appropriate records; maintains office supplies by notifying Practice Manager when items are needed, sorting, storing supplies; and restocking exam / procedure rooms. Work flexible hours to adequately staff department and assist other locations with staffing needs as they arise. Exhibits behaviors reflective of Memorial’s core values: Compassion, Accountability, Respect, Excellence, and Service. Demonstrates regular and predictable attendance. Attends all mandatory education and in-services (i.e., team training, safety, infection control, etc.); completes mandatory health requirements. Employee performs within the prescribed limits of the hospital and department’s Ethics and Compliance program and is responsible to detect, observe and report compliance variances to their immediate supervisor, or upward through the chain of command, the Compliance Officer, or the hospital hotline. What You'll Bring: Graduation from an accredited school of nursing with current LPN licensure in the state of Ohio. Maintains certification in American Heart Association’s (AHA) Basic Life Support (BLS) within 90 days of employment and maintains bi-annual certification. Maintains LPN licensure in the state of Ohio. Why Join Us: Monday-Friday Opportunity with hours between 7 am- 5 pm Supportive work environment that values collaboration, innovation, and professional growth. Office closed for 6 holidays (with pay) Free membership to our employee wellness center Competitive salary and benefits package 401k Medical, Dental Insurance, Vision, and Life Insurance Flexible Spending Account Chance to make a meaningful impact on the lives of patients and families in our community Tuition Reimbursement Kidzlink Discounted Daycare Employee Recognition Free Parking Community/Family Atmosphere Mill Valley is: Approx. 20 minutes away from Dublin, OH Approx. 20 minutes away from Hillard, OH Approx. 30 minutes away from Delaware, OH Approx. 30 minutes away from Powell, OH We look forward to seeing your application! It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701.
Up to $5,000 sign on bonus! We are looking for an MA to join our fast-pace team at our Plain City Team! In this position, you will have the opportunity to learn how to do the clinical and clerical pieces of patient care to better support the patient’s experience. In this role you will work between 7:00 am-5:30 pm. Clinical responsibilities: accompanying patients to exam/procedure room; assisting patients as needed with walking, performs injections, EKG’s, point of care testing on patients at the direction of a provider, dressing, collecting specimens, preparing for exam, etc.; collecting & documenting patient history; performing screenings per provider guidelines; assisting physician with various procedures; sterilization, instrument wrapping and autoclaving; checking vital signs; prescription verifications with physician’s orders; minor surgery assists including surgical tray set-up pre/post-surgical care, applying dressing, and suture removal; biohazard waste disposal and monitoring; laboratory procedures; quality control methods; capillary punctures and venipuncture; specimen handling; emergency triage and first aid, verify vaccine orders and insurance eligibility for patients utilizing the VaxCare system; Maintain appropriate daily workflow to ensure patients are seen in a timely fashion, facilitate after care and follow-up for patients at conclusion of appointments, etc. Assist with completion of registration/front desk functions Respond to patient messages, contact patients regarding test results and enter patient recalls Manage medication refills and medication prior authorization Assist with completion of Short Term Disability and/or FMLA forms Educate patients about medication, special diets and preparation for testing Why Join Us: Monday-Friday Opportunity Supportive work environment that values collaboration, innovation, and professional growth. Office closed for 6 holidays (with pay) Free membership to our employee wellness center Competitive salary and benefits package 401k Medical, Dental Insurance, Vision, and Life Insurance Flexible Spending Account Chance to make a meaningful impact on the lives of patients and families in our community Tuition Reimbursement Kidzlink Discounted Daycare Employee Recognition Free Parking Community/Family Atmosphere Marysville is: Approx. 10 minutes away from Dublin, OH Approx. 20 minutes away from Hillard, OH Approx. 20 minutes away from Delaware, OH Approx. 20 minutes away from Powell, OH What You'll Bring/Requirements: One of the following are required: American Association of Medical Assistants (AAMA) certification, Registered Medical Assistant (RMA) certification, National Certified Medical Assistant (NCMA). Maintains certification in American Heart Association’s (AHA) Basic Life Support (BLS) within 90 days of employment and maintains bi-annual certification. Maintains continuous Medical Assistant certification. We look forward to seeing your application! It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701.
We are looking for a Medical Assistant, to join our outpatient care team! Although this position does not have a guaranteed number of hours, it is a Monday-Friday Opportunity with hours between 7 am-5 pm. In this position you will float between the following locations: Plain City, Urbana, Richwood, and Marysville. What You'll Do: Act as a vital team member and fill in for co-workers when they are off What You'll Bring: Completion of post secondary program in Medical Assistant and experience as a physician offices preferred, and/or equivalent combination of education and experience. American Association of Medical Assistants certification (AAMA), Registered Medical Assistant certification (RMA), National Certified Medical Assistant (NCMA) preferred. Why Join Us: Monday-Friday Opportunity with hours between 7 am- 5 pm Supportive work environment that values collaboration, innovation, and professional growth Guaranteed 6 holidays off (not paid) Free membership to our employee wellness center Chance to make a meaningful impact on the lives of patients and families in our community Kidzlink Discounted Daycare Employee Recognition Free Parking Community/Family Atmosphere We look forward to seeing your application! It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701. My Memorial, My Career Choice
$3,000 sign on bonus We are looking for someone to join our Jerome Primary Care Facility as a Medical Assistant. This is a Monday-Friday (7am-5:30pm) opportunity with offices being closed during the 6 major holidays (with pay). We look forward to seeing your applications. What You'll Do: Room patients, perform vitals, obtain and update medical history and chief compliant Assist with minor in office procedures and surgery scheduling Respond to patient messages, contact patients regarding test results and enter patient recalls Manage medication refills and medication prior authorization Assist with completion of Short Term Disability and/or FMLA forms Educate patients about medication, special diets and preparation for testing Why Join Us: Monday-Friday Opportunity (7am-5:30pm) Supportive work environment that values collaboration, innovation, and professional growth. Office closed for 6 holidays (with pay) Free membership to our employee wellness center Competitive salary and benefits package 401k Medical, Dental Insurance, Vision, and Life Insurance Flexible Spending Account Chance to make a meaningful impact on the lives of patients and families in our community Tuition Reimbursement Kidzlink Discounted Daycare Employee Recognition Free Parking Community/Family Atmosphere Marysville is: Approx. 10 minutes away from Dublin, OH Approx. 20 minutes away from Hillard, OH Approx. 20 minutes away from Delaware, OH Approx. 20 minutes away from Powell, OH What You'll Bring/Requirements: Active LPN License and degree from an accredited school We look forward to seeing your application! It is our commitment to inclusivity and diversity and our ongoing determination to provide a welcoming and inclusive environment for all staff and guests of the Hospital, regardless of age, color, disability, gender, gender expression or gender identity, genetic information, national origin, race, religion, sexual orientation, or veteran status. For any questions or needed accommodations, please contact Memorial Health Human Resources at 937.578.2701. #JeromeLocation
