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Regional Clinical Marketing Liaison (RN Or RT)

Summary of Duties Responsible for managing and overseeing the referral process and marketing of all hospitals and surrounding t...

Posted 4 days ago

Summary of Duties Responsible for managing and overseeing the referral process and marketing of all hospitals and surrounding territories. Responsible for developing and implementing census volume growth strategies within a geographic region or territory in order to maintain referral relationships, generate new referrals and meet census volume goals. This position will require 100% travel throughout the division. Essential Job Functions * Collaborates with Director of Business Development to ensure consistent, appropriate admissions, transfers and marketing to maximize referrals and facilitate admissions. * Communicates Concerns, market information on competitors, and gives feedback from referral sources to the Director of Business Development. * Serves as an interim Clinical Marketing Liaison on an as needed basis. * Works with Director of Business Development in identifying, overseeing and facilitating marketing opportunities for referring hospitals, physicians, community and all other referral sources as it relates to an increase in census volume growth for all hospitals, as needed. * Collaborates with liaisons on strategic territory planning as needed. * Assists liaisons with personal sales/marketing strategies and goals as needed. * Oversees territory schedules as relates to census volume growth. * Assists with the execution of reports requested by the Director of Business Development. * Develops or assists in the development and implementation of hospital sales strategies and goals as part of the marketing planning process in order to increase census volumes and generate additional referrals (weekly, quarterly). * Visits physician offices (inside/outside the host hospital) for the purpose of generating new referrals through solid relationship building and educational marketing. * Markets services to all potential referral sources (physicians, case managers, discharge planners, prospective patients and other target groups according to the marketing plan(s). * Assists with coordination of marketing events throughout the year to promote and provide marketing and educational opportunities for potential referral sources. * Attends in-services, Continuing Medical Education, and Continuing Education Units programs sponsored by the Organization. * Assists with pre-admission evaluations and provides necessary information to team for purpose of making decision regarding admission, i.e. medication, equipment, procedures, medical equipment, etc.) within 24-48 hours of the referral. * Performs on an as needed basis thorough pre-admission patient assessment and determines acceptance based on the following admission criteria: medical necessity (SI/IS), projected length of stay (based on appropriate projected DRG), projected clinical outcome (attainable goal), viable discharge plan, and necessary resource availability (beds, monitors, staffing, etc.). * Makes appropriate referrals to physician advisor when documented care does not reflect defined criteria (SI/IS) per specific payor. * Completes evaluation communication form and place under the progress note tab in the chart. Update as needed. * Coordinates and processes admission to facility for efficient continuity of care, including physician communication, obtaining insurance verification and benefits with completion of pre-certification as indicated, communication with patient/family/significant other and referral hospital contacts. * Collaborates and teams with clinical staff in facilitating and implementing physician orders to aid in the timely completion of patient care across the continuum. * Collaborates with all appropriate Noland Health Services departments and/or hospitals to strengthen relationships and facilitate the referral process. * Identifies and reports opportunities to improve the quality of care for patients in the organization, including patient complaint management and any unusual patient care issues. Education Must possess a degree in Nursing or Respiratory Therapy. Bachelor Degree preferred. Experience Minimum of two (2) years clinical and marketing/sales experience required. Utilization Review experience is preferred.

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Rehab Liaison- Clinical License Or Healthcare Sales Required

Encompass Health Birmingham AL, 35202

Encompass Health Lakeshore Rehabilitation Hospital The Rehab Liaison is responsible for developing census as defined through ta...

Posted 4 days ago

Encompass Health Lakeshore Rehabilitation Hospital The Rehab Liaison is responsible for developing census as defined through targeted goals of the business plan and developing referral relationships within the geographic territory with an emphasis on face-to-face contacts. In addition, the liaison will assist with coordination of referral to admission conversion process and represent our company in community-related activities. In addition, the position: * Utilizes market analysis data in individual territory identifying new business and potential opportunities. * Recognizes barriers to admission, responds appropriately and follows up on admissions variables. * Understands healthcare operations, legal guidelines, competitive analysis, and market place trends * Provides in-services and professional presentations for referral sources, community groups and other organizations, regarding our company's services, programs and outcomes. The Rehab Liaison creates an environment and culture that enables the hospital to fulfill its mission by providing patient safety and patient-centered treatment. Benefits To attract and retain the best professionals, we offer a comprehensive and competitive benefits package that includes medical, dental, vision, 401(k), college savings plan, employee assistance program, pre-paid legal plan and much more. For more information on available benefits, please click here. What types of patients will you see? We are an acute rehabilitation hospital setting. Typically our patients spend an average of 2-4 weeks in our hospital and come to us with a wide variety of diagnosis such as: stroke, spinal cord injury, brain injury, various neurological disorders, rheumatoid arthritis, osteoarthritis, amputation, joint replacement, fractures, multiple trauma, cardiac conditions, and pulmonary conditions. 80% of our patients are discharged directly home. We use evidence-based practice guidelines to treat our patients. We utilize our clinical outcomes to assess and improve our treatment interventions and programs. We participate in a national outcomes database, which provides benchmarks and sophisticated outcome reports to help us continually analyze and improve our patient outcomes. Helping you become better is critical to our success - You will be paired with mentors; attend in-house as well as external educational programs. The treatment team is made up of full time therapists, nurses, social workers, pharmacists and medical staff; and we offer educational benefits if you are interested in continuing your education. Job Code: 100147 License or Certification: * Current driver's license in state employed and acceptable driving record according to company policy * Current State Professional License required * Current CPR certification preferred * CRRN preferred. Education, Training and Years of Experience: * Bachelor's Degree preferred or equivalent job experience * Minimum 2 years experience as clinician or tech in healthcare environment preferred * Minimum 1 year experience as nurse liaison or successful sales experience in healthcare environment preferred * Familiarity with acute hospital, rehab hospitals, and local healthcare market preferred Machines, Equipment Used: * General office equipment such as telephone, copy machine, fax machine, calculator, computer. Physical Requirements: * Good visual acuity and ability to communicate. * Ability to lift and push/pull a minimum of 30 pounds. Reasonable assistance may be requested when lifting, pushing, and/or pulling are undertaken which exceeds these minimum requirements. Compliance: * Adheres to the company's Standards of Business Conduct. * Maintains current licensure and/or certifications, if applicable. Skills and Abilities: * Ability to speak, read, write, and communicate effectively. * Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner. * Ability to work independently without supervision. Environmental Conditions: * Indoor, temperature controlled, smoke-free environment. Occasional outdoor exposure. * Exposure or potential exposure to blood and body fluids may be required. * Handicapped accessible. * May work under stressful circumstances at times. Proficiency or Productivity Standards: * Meets established attendance standards. * Adheres to hospital/department dress code including wearing ID badge. * May be required to work weekdays and/or weekends, evenings and or night shifts if needed to meet deadlines. * May be required to work on religious and/or legal holidays on scheduled days/shifts. * Will be required to work as necessary during disaster situations, i.e., before, during or after a disaster. * May be required to stay after workday to assist after a disaster situation until relief arrives. * May be required to perform other duties as assigned by supervisor. * Must be able to travel overnight to fulfill essential training requirements. Travel is infrequent, but necessary for training purposes. Minimum required travel includes training at Corporate Office in Birmingham, AL. Address: 3800 Ridgeway Drive, Birmingham 35209 Shift: Day Job Job ID: 1822916

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Rehab Liaison- Clinical License Or Healthcare Sales Required

Healthsouth Corporation Birmingham AL, 35202

Encompass Health Lakeshore Rehabilitation Hospital The Rehab Liaison is responsible for developing census as defined through ta...

Posted 5 days ago

Encompass Health Lakeshore Rehabilitation Hospital The Rehab Liaison is responsible for developing census as defined through targeted goals of the business plan and developing referral relationships within the geographic territory with an emphasis on face-to-face contacts. In addition, the liaison will assist with coordination of referral to admission conversion process and represent our company in community-related activities. In addition, the position: * Utilizes market analysis data in individual territory identifying new business and potential opportunities. * Recognizes barriers to admission, responds appropriately and follows up on admissions variables. * Understands healthcare operations, legal guidelines, competitive analysis, and market place trends * Provides in-services and professional presentations for referral sources, community groups and other organizations, regarding our company's services, programs and outcomes. The Rehab Liaison creates an environment and culture that enables the hospital to fulfill its mission by providing patient safety and patient-centered treatment. Benefits To attract and retain the best professionals, we offer a comprehensive and competitive benefits package that includes medical, dental, vision, 401(k), college savings plan, employee assistance program, pre-paid legal plan and much more. For more information on available benefits, please click here. What types of patients will you see? We are an acute rehabilitation hospital setting. Typically our patients spend an average of 2-4 weeks in our hospital and come to us with a wide variety of diagnosis such as: stroke, spinal cord injury, brain injury, various neurological disorders, rheumatoid arthritis, osteoarthritis, amputation, joint replacement, fractures, multiple trauma, cardiac conditions, and pulmonary conditions. 80% of our patients are discharged directly home. We use evidence-based practice guidelines to treat our patients. We utilize our clinical outcomes to assess and improve our treatment interventions and programs. We participate in a national outcomes database, which provides benchmarks and sophisticated outcome reports to help us continually analyze and improve our patient outcomes. Helping you become better is critical to our success - You will be paired with mentors; attend in-house as well as external educational programs. The treatment team is made up of full time therapists, nurses, social workers, pharmacists and medical staff; and we offer educational benefits if you are interested in continuing your education. Job Code: 100147 License or Certification: * Current driver's license in state employed and acceptable driving record according to company policy * Current State Professional License required * Current CPR certification preferred * CRRN preferred. Education, Training and Years of Experience: * Bachelor's Degree preferred or equivalent job experience * Minimum 2 years experience as clinician or tech in healthcare environment preferred * Minimum 1 year experience as nurse liaison or successful sales experience in healthcare environment preferred * Familiarity with acute hospital, rehab hospitals, and local healthcare market preferred Machines, Equipment Used: * General office equipment such as telephone, copy machine, fax machine, calculator, computer. Physical Requirements: * Good visual acuity and ability to communicate. * Ability to lift and push/pull a minimum of 30 pounds. Reasonable assistance may be requested when lifting, pushing, and/or pulling are undertaken which exceeds these minimum requirements. Compliance: * Adheres to the company's Standards of Business Conduct. * Maintains current licensure and/or certifications, if applicable. Skills and Abilities: * Ability to speak, read, write, and communicate effectively. * Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner. * Ability to work independently without supervision. Environmental Conditions: * Indoor, temperature controlled, smoke-free environment. Occasional outdoor exposure. * Exposure or potential exposure to blood and body fluids may be required. * Handicapped accessible. * May work under stressful circumstances at times. Proficiency or Productivity Standards: * Meets established attendance standards. * Adheres to hospital/department dress code including wearing ID badge. * May be required to work weekdays and/or weekends, evenings and or night shifts if needed to meet deadlines. * May be required to work on religious and/or legal holidays on scheduled days/shifts. * Will be required to work as necessary during disaster situations, i.e., before, during or after a disaster. * May be required to stay after workday to assist after a disaster situation until relief arrives. * May be required to perform other duties as assigned by supervisor. * Must be able to travel overnight to fulfill essential training requirements. Travel is infrequent, but necessary for training purposes. Minimum required travel includes training at Corporate Office in Birmingham, AL.

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Clinical Liaison - Lpn/Lvn

Diversicare Birmingham AL, 35202

Overview MAKE YOUR MARK, MAKE A DIFFERENCE! Diversicare is a premier provider of post-acute healthcare services with a stron...

Posted 1 week ago

Overview MAKE YOUR MARK, MAKE A DIFFERENCE! Diversicare is a premier provider of post-acute healthcare services with a strong legacy of quality care. We strive to foster a culture of transparency, support, and innovation. Our Mission is to improve every life we touch by providing exceptional healthcare and exceeding expectations . We are proud to provide work/life integration for our team members and offer a comprehensive benefits package. Diversicare operates 76 centers in ten states primarily in the Midwest, Southeast and Southwest. As Diversicare team member, you will play an instrumental role in the care of our patients and residents, our most important responsibility. We are seeking compassionate team members to assist our patients and residents with activities of daily living. We are committed to providing a supportive and collaborative work environment for our team members. A qualified candidate is responsible for all key accountabilities in a manner that is reflective of Diversicare's Mission and Core Values: Integrity, Excellence, Compassion, Teamwork, and Stewardship. If you are looking for an opportunity to make a difference in the lives of patients and residents you serve, Diversicare is the place for you. Responsibilities The key accountabilities of the Clinical Liaison are: * Complete clinical assessments and determine appropriateness, working cohesively with care team members for a safe, seamless transition * Collaborate with center team members to meet or exceed Key Account Management and admission goals * Accurately represent Center's Features-Benefits-Impact, effectively demonstrating use of Diversicare Sales Steps * Communicates effectively through written documentation and verbal communication * Champion quality of care and advocate of the customer experience Qualifications Experience and qualifications: * Registered Nurse (RN) or Licensed Practical Nurse/Licensed Vocational Nurse (LPN). License is current and in good standing * 1 to 2 years' experience in skilled care or long term care * 1 to 2 years' sales, marketing/admissions preferred * Established contacts and relationships with hospital and physician customers preferred * Strong medical assessment skills and HIPAA compliance track record Diversicare is committed to being an equal opportunity employer. Diversicare does not discriminate in employment opportunities or practices on the basis of race, color, religion, sex (including gender identity), national origin, age, or disability, sexual orientation, citizenship, marital status, veteran status, genetic information, or any other characteristic protected by law.

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Hospice Clinical Manager (Rn)

Envision Healthcare Birmingham AL, 35202

Overview St. Vincent's Hospice is growing, and we are seeking an experienced Registered Nurse Clinical Manager to join our team...

Posted 1 week ago

Overview St. Vincent's Hospice is growing, and we are seeking an experienced Registered Nurse Clinical Manager to join our team in Birmingham! Hours are Monday - Friday 8am-5pm We're Proud To Offer: Outstanding Pay Medical, Dental, Vision, Life, ST/LTD Benefits 401K & Tuition Reimbursement Positive Work/Life Balance Room For Professional Growth Exceptionally Supportive Leadership Team Responsibilities POSITION SUMMARY: Primary responsibility is to coordinate and manage all clinical activities. Assumes responsibility for continuity, appropriateness, and quality of service delivered by the Agency. Oversees Clinical Supervisors. Essential Duties and Responsibilities: * Oversees the assignment of appropriate staff to all cases. * Assures all staff are appropriately oriented for the cases assigned. * Assures compliance with state, federal, and local laws. * Assists in the recruitment, interviewing, and hiring of field staff as necessary. * Coordinates and assists the interdisciplinary team in the development and implementation of patient care policies. * Assures accuracy of visit delivery in conjunction with order frequencies. * Reviews patient medical files on a regular basis and addresses any discrepancies noted. * Assists the QA Manager in identifying educational activities for staff including in-services, based on employee needs and promotes staff development. * Supervises day-to-day patient care activities and is available to field staff for assistance with problems or concerns. * Supervises Clinical Supervisors for the agency's services. * Supervises Service Coordinators/Schedulers and scheduling activities for the agency's services. * Functions as the HIPAA and Red Flag Compliance Officer. * Adhere to all company policies and procedures. * Adherence to and compliance with information systems security is everyone's responsibility. It is the responsibility of every computer user to: Know and follow Information Systems security policies and procedures. Attend Information Systems security training, when offered. Report information systems security problems. * Mentor employees, provided input for performance evaluations, counsel and provide disciplinary actions to assigned personnel in conjunction with Supervisor, and works to facilitate individual and team development that drives positive results. Non-Essential Duties and Responsibilities: * Perform other duties as assigned. Minimum Qualifications: Education/Licensing/Certification: * Must be a Registered Nurse in the State and be a graduate of an approved school of professional nursing. Experience: * One (1) year of home health care experience * One (1) year of supervisory experience preferred Knowledge and Skills: * Excellent leadership skills * Good computer skills * Good interpersonal, and organizational skills * Good communication skills both written and verbal. * Ability to problem solve * Detail oriented * Nursing skills performed under accepted nursing standards

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Principal Field Clinical Representative, Clinical Solutions Rhythm - Birmingham, AL Area Job

Boston Scientific Birmingham AL, 35202

Date: Sep 21, 2018 Location:Birmingham, AL, US, 35201 Company: Boston Scientific Primary Location: [[filter2]] Purpose...

Posted 4 weeks ago

Date: Sep 21, 2018 Location:Birmingham, AL, US, 35201 Company: Boston Scientific Primary Location: [[filter2]] Purpose and Passion • Comprehensive Benefits • Life-Work Integration • Community • Career Growth At Boston Scientific, you will find a collaborative culture driven by a passion for innovation that keeps us connected on the most essential level. With determination, imagination and a deep caring for human life, we're solving some of the most important healthcare industry challenges. Together, we're one global team committed to making a difference in people's lives around the world. This is a place where you can find a career with meaningful purpose—improving lives through your life's work. About the role: Promotes commercially-approved company products through education of current and potential customers, implant and patient clinic coverage within a defined region by providing clinical education, sales strategy and support in order to assist in achieving projected sales goals and increasing sales revenues within product segments. May also support day-to-day field execution and management of Boston Scientific clinical trials at selected clinical trial centers centers in accordance with all applicable SOPs. Your Responsibilities will include: * Develops relationships with hospital personnel (e.g. through casual conversation, meetings, participation in conferences) and to identifies key decision makers in order to facilitate future sales. * Trains on and maintains knowledge of clinical trial protocols, CRM Clinical Department standard operating procedures, and compliance toward the regulations of world-wide regulatory bodies to meet corporate and departmental objectives. * Manages clinical trial activity within his/her assigned territory which includes but is not limited to completing Interest Visits and Site Initiation Visits. * Educates clinical investigators on clinical trial protocols, clinical process, and investigational products and features. * Responds to customer needs and complaints regarding products and service by developing creative and feasible solutions or working with other related personnel (e.g., sales, clinical research, marketing, technical support) to develop optimal solutions. * Follows company and divisional guidelines for managing commercial inventory and, if applicable, investigational product inventory. * On-call duties may be required 24 hours a day, 7 days per week; on rotational basis. What we're looking for in you: Basic Qualifications * Minimum 2 years work experience with Bachelor's degree in Science, Math, Business, Nursing OR equivalent technical work experience * Minimum 2 years of technical work experience and/or MBA * Strong technical aptitude; the ability to understand, communicate and train others in use of complex medical software algorithms as it pertains to device therapy and diverse disease states. * Strong ability to communicate clearly and effectively with all levels of the medical community including patients. * Demonstrated ability to be flexible, adaptable and work in a fast-paced, constantly changing work environment where urgency dictates work schedule. * Ability to take rotational 24/7 call with a sales team involving holidays, weekends. * Ability to work independently where daily schedule varies by hours worked and tasks managed. Preferred Qualifications * Previous experience working in a Cardiac Catheterization (Cath) Lab and/or Electrophysiology (EP) Lab * Medical device sales, clinical education and/or clinical research experience About us As a global medical technology leader for more than 35 years, our mission at Boston Scientific (NYSE: BSX) is to transform lives through innovative medical solutions that improve the health of patients. If you're looking to truly make a difference to people both around the world and around the corner, there's no better place to make it happen. Boston Scientific is an Equal Opportunity Employer Posting Notes: [[filter2]]||(n/a)||Sales Training||[[mfield2]] Nearest Major Market: Birmingham Job Segment: Clinic, Medical, Medical Lab, Law, Medical Technology, Healthcare, Legal

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Field Clinical Representative II, Clinical Solutions Rhythm - Birmingham, AL Area Job

Boston Scientific Birmingham AL, 35202

Date: Sep 21, 2018 Location:Birmingham, AL, US, 35201 Company: Boston Scientific Primary Location: [[filter2]] Purpose...

Posted 4 weeks ago

Date: Sep 21, 2018 Location:Birmingham, AL, US, 35201 Company: Boston Scientific Primary Location: [[filter2]] Purpose and Passion • Comprehensive Benefits • Life-Work Integration • Community • Career Growth At Boston Scientific, you will find a collaborative culture driven by a passion for innovation that keeps us connected on the most essential level. With determination, imagination and a deep caring for human life, we're solving some of the most important healthcare industry challenges. Together, we're one global team committed to making a difference in people's lives around the world. This is a place where you can find a career with meaningful purpose—improving lives through your life's work. About the role: Promotes commercially-approved company products through education of current and potential customers, implant and patient clinic coverage within a defined region by providing clinical education, sales strategy and support in order to assist in achieving projected sales goals and increasing sales revenues within product segments. May also support day-to-day field execution and management of Boston Scientific clinical trials at selected clinical trial centers centers in accordance with all applicable SOPs. Your Responsibilities will include: * Develops relationships with hospital personnel (e.g. through casual conversation, meetings, participation in conferences) and to identifies key decision makers in order to facilitate future sales. * Trains on and maintains knowledge of clinical trial protocols, CRM Clinical Department standard operating procedures, and compliance toward the regulations of world-wide regulatory bodies to meet corporate and departmental objectives. * Manages clinical trial activity within his/her assigned territory which includes but is not limited to completing Interest Visits and Site Initiation Visits. * Educates clinical investigators on clinical trial protocols, clinical process, and investigational products and features. * Responds to customer needs and complaints regarding products and service by developing creative and feasible solutions or working with other related personnel (e.g., sales, clinical research, marketing, technical support) to develop optimal solutions. * Follows company and divisional guidelines for managing commercial inventory and, if applicable, investigational product inventory. * On-call duties may be required 24 hours a day, 7 days per week; on rotational basis. What we're looking for in you: Basic Qualifications * 0-2+ years work experience with Bachelor's degree in Biomedical Engineering, Science, Math, Business, Nursing preferred and/or equivalent technical work experience. * 0-2+ years in a Boston Scientific clinical position. * Exhibited proven leadership skills with consistently high performance ratings. * The ability to understand, communicate and train others in the use and understanding of complex medical device software algorithms as it pertains to device therapy and diverse disease states. * Ability to communicate clearly and effectively with all levels of the medical community including patients. * Demonstrated ability to work as part of a highly-motivated team where flexibility and adaptability in a fast-paced, constantly changing work environment are paramount and urgency often dictates dynamic work schedule. * Ability to take rotational 24/7 call with a sales team involving holidays, weekends. * A self-starter with the ability to work independently, efficiently and effectively where daily schedule varies by hours worked and tasks managed while remaining accountable to company, region and team goals. Preferred Qualifications: * Previous experience working in an Electrophysiology (EP) Lab, device clinic and/or Cardiac Catheterization (Cath) Lab. * Medical device sales, sales support, clinical education and/or clinical research experience. * IBHRE or ability to obtain certification About us As a global medical technology leader for more than 35 years, our mission at Boston Scientific (NYSE: BSX) is to transform lives through innovative medical solutions that improve the health of patients. If you're looking to truly make a difference to people both around the world and around the corner, there's no better place to make it happen. Boston Scientific is an Equal Opportunity Employer Posting Notes: [[filter2]]||(n/a)||Sales Training||[[mfield2]] Nearest Major Market: Birmingham Job Segment: Clinic, Medical, Medical Lab, Engineer, Law, Healthcare, Engineering, Legal

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Clinical Solutions MD

Aetna Inc. Birmingham AL, 35202

POSITION SUMMARY Operating with a balance of internal and external-facing activities that support a shift to a higher-touch...

Posted 3 weeks ago

Job Description POSITION SUMMARY Operating with a balance of internal and external-facing activities that support a shift to a higher-touch, patient-centric focus, the Medical Director will develop, implement, support, and promote population health strategies, tactics, policies, and programs that drive the delivery of high value healthcare to establish a sustainable competitive business advantage for Aetna. These strategies, policies, and programs are comprised of care management, utilization management, quality improvement, network management as well as clinical coverage protocol. The Medical Director will be provider facing and have fluency in data analytics. This position supports our GLAM market (GA / LA / AL / MS) and can be a work at home position. Louisiana location is highly preferred! Fundamental Components: Ability to collaborate with all stakeholders, understanding the guidelines/basics (how to access) the requirements, opportunities to shape within the scope in the role as a Health plan medical director. Analytics-Oriented Care: Ability to analyze data (e.g., medical cost trends) and articulate trend and solutions. Ability to manage complex cases and client relationships with plan sponsors. Proactive Virtual and Physician Engagement: Leveraging multi-channel platforms and digital technology to interface with internal and external customers in virtual and physical settings. End to End Market Understanding: Strong business acumen. Understands and proficient articulating products, financial impacts and market demands. Consultant and supplier of actionable information. Expertise in market/state DOL regulations delivering HEDIS/STARS consultation. Communications: Both oral and written skills and comfort in presenting to varied groups. Key Responsibilities: Building and fostering relationships and partnering with the external community and providers in a pro-active approach to population health. Using data analytics to inform and influence population health to drive behavior change and expand Aetna's medical management programs to address specific member conditions across the continuum of care. Collaborating with the Medical Management staff both internally and externally ensuring timely and consistent responses to members and providers. Providing clinical expertise and business direction in support of medical management programs through active collaboration and participation in clinical team activities. Acting as lead business and clinical liaison to network providers and facilities to support the effective execution of medical services programs by the clinical teams. Attend & engage in Sales presentation meetings when necessary providing the value prop/story behind the partnerships Executing predetermination reviews, reviews of claim determinations, providing clinical, coding, and reimbursement expertise. Manage UM transactional work(front line reviews and appeals). Building and inspiring a culture of continuous improvement for better quality of care. Creating products that utilize patient engagement in a new and effective manner utilizing tools and analytics. Overseeing utilization review/quality assurance directing case management. Provide UM services based on business demands and shifting business needs BACKGROUND/EXPERIENCE 2-3 years of experience in Health Care Delivery System e.g., Clinical Practice and Health Care Industry. Previous Managed Care experience with a payer / insurance company preferred EDUCATION The highest level of education desired for candidates in this position is a MD or DO. LICENSES AND CERTIFICATIONS And Active Unrestricted State Medical License is required. Active Board Certification in a recognized specialty is required FUNCTIONAL EXPERIENCES Functional - Medical Management/Medical Management - Administration/Management/1-3 Years Functional - Medical Management/Medical Management - Concurrent Review/1-3 Years Functional - Medical Management/Medical Management - Physician Relations/1-3 Years Functional - Clinical / Medical/Direct patient care (hospital, private practice)/1-3 Years Functional - Clinical / Medical/General Management/1-3 Years TECHNOLOGY EXPERIENCES Technical - Desktop Tools/Microsoft Word/1-3 Years/End User Technical - Desktop Tools/Microsoft Outlook/1-3 Years/End User Technical - Desktop Tools/Microsoft PowerPoint/1-3 Years/End User Technical - Desktop Tools/TE Microsoft Excel/1-3 Years/End User DESIRED SKILLS Benefits Management/Maximizing Healthcare Quality/ADVANCED Service/Providing Solutions to Constituent Needs/ADVANCED ADDITIONAL JOB INFORMATION Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come. We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence. Together we will empower people to live healthier lives. Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities. We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard. Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Aetna takes our candidates's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.

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Clinical Manager

Amedisys Home Health Services Homewood AL, 35209

What You Will Do: As a clinical manager for Amedisys, you will report directly to the operational leader and serve as a key mem...

Posted 1 month ago

What You Will Do: As a clinical manager for Amedisys, you will report directly to the operational leader and serve as a key member of care center operations and management team by leading a full team of multidiscipline, healthcare professionals. Your work would include responsibilities as a clinical supervisor and manager as well as responsibility to coordinate, provide and maintain the highest standards of care. You may occasionally provide one on one nursing care and treatment to patients in the home, and when required, may fulfill role as Agency Supervising Nurse. * Manages and coordinates the provision of quality home care services to patients from admission to discharge. * Participates with the physician, referral sources, Clinical/Branch Director and professional staff in decisions regarding patient eligibility and suitability for home care services. * Evaluates, and regularly re-evaluates the needs of the patient; initiates, develops, implements and makes necessary revisions to the patient's plan of care. Assesses the patient's continual care needs. * Works cooperatively with the operational leader on staffing, referral sources, physician and client concerns/needs. * Assists with and coordinates training of appropriate staff and conducts performance evaluations of team to ensure quality care, compliance, and fiscal responsibility. * Coordinates regular case/team conferences and promotes communication of information relevant to the patient care process to ensure quality of care and coordination of services. * Participates in agency quality assurance activities designed to improve quality and continuity of patient care * Applies knowledge of Federal/State rules and regulations, ACHC standards, and other regulatory requirements to ensure compliance and quality standards for the patients. Required: * Current and unencumbered license to practice as a Registered Nurse specific to that state the employee is assigned to work by the Company. * Minimum of three (3) years of clinical experience as a registered nurse (RN). One of those years must consist of full-time experience in providing direct patient care in the home health setting* * Current CPR certification. * Valid Driver's License and reliable transportation and agency required liability insurance. * some states have specific requirements related to education and experience beyond the listed general requirement Preferred: * Bachelor of Science in Nursing (BSN) degree * More than one (1) year supervisory/management experience in home care * ICD10 certification * Oasis certification * Financial management experience

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Clinical Reimbursement Coordinator (Full Time)

Genesis Healthcare LLC Gardendale AL, 35071

CLINICAL REIMBURSEMENT COORDINATOR RN, DAY SHIFT 08:00A-04:30P MONDAY-FRIDAY. POSITION SUMMARY: The Clinical Reimbursement ...

Posted 3 weeks ago

Job Description CLINICAL REIMBURSEMENT COORDINATOR RN, DAY SHIFT 08:00A-04:30P MONDAY-FRIDAY. POSITION SUMMARY: The Clinical Reimbursement Coordinator (RN) manages the overall process and tracking of all Medicare/Medicaid case-mix documents in order to assure appropriate reimbursement for services provided within the Center. Conducts concurrent MDS reviews to assure achievement of maximum allowable RUG categories. He/she will integrate information from nursing, dietary, social services, restorative, rehabilitation and physician services to ensure appropriate reimbursement. RESPONSIBILITIES/ACCOUNTABILITIES: 1. RevenueOptimization - Resource Utilization: 1.1 Tracks Medicare Customers to determine continued and appropriate Medicare eligibility and benefit period by determining skilled level of need; 1.2 Prior to admission, reviews pre-admission intake information with the External Care Coordinator or Admissions Coordinator to estimate RUG levels for Medicare Customers and to identify potential resource costs, consider formularies, and communicate findings to Administrator/care team; 1.3 Performs concurrent MDS review to insure appropriate RUGs category is achieved through the capture of appropriate clinical information. Identifies opportunities to enhance reimbursement; 1.4 Directs the interdisciplinary team process to communicate opportunities to ensure capturing of all resources; 1.5 Collaborates with Reimbursement Services to review RUG reports and identify RUG categorization. 2. MDS Schedule and Tracking: 2.1 Maintains an accurate schedule of all MDS assessments to include the proper reference dates throughout the Customer's stay and ensures the accurate and timely submission of the MDS assessments including case-mix, OBRA and OSRA required assessments; 2.2 Communicates to the Care Plan Coordinator the MDS assessment schedule to ensure timely facilitation of the care planning process. 2.3 Completes the admission and discharge tracking form and maintains tracking system for admission/re-entry/discharge; 2.4 Manage the data entry function to ensure the accuracy of the MDS and verify electronic transmissions to Genesis and the state. 3. Billing: 3.1 Coordinate with the Center Business Office, and or/Centralized Business Office when available throughout the month, to communicate case-mix data required for billing such as RUGs categories, modifiers, state case-mix scores, etc. 4. Education and Resource: 4.1 Serves as the Center resource for MDS/RUGs and state case-mix systems; 4.2 Provides case-mix education to the interdisciplinary team as appropriate; 4.3 Instructs Center staff in terminology, language, and format that is required by MDS; 4.4 Communicates with Center Administrator, interdisciplinary team and Reimbursement Services regarding any changes in case-mix regulations such as PPS and/or state specific case-mix systems; 4.5 Trains backup personnel for the Clinical Reimbursement Coordinator; 5. Other Duties 5.1 Assists in the preparation of all requests from appropriate State and/or federal regulatory agencies or agents regarding payment of services (reconsideration, denials appeals, etc.); 5.2 Maintains all reports and transmission data in a systematic format and stores in a safe, locked area; 5.3 Maintains a current and comprehensive knowledge of MDS and Medicare/ Medicaid reimbursement; 5.4 Implements all required forms, procedures and processes relative to job responsibilities; 5.5 Performs other related duties as requested. Compliance Responsibilities * Complies with applicable legal requirements, standards, policies and procedures including but not limited to those within the Compliance Process, Standard/Code of Conduct, Federal False Claims Act and HIPAA. * Participates in required orientation and training programs. * Promptly reports concerns and suspected incidences of non-compliance to supervisor, Compliance Liaison or to the Compliance Officer via the Integrity Hotline. * Cooperates with monitoring and audit functions and investigations. * Participates, as requested, in quality assurance and process improvement activities. CCRN QUALIFICATIONS: SPECIFIC EDUCATIONAL/VOCATIONAL REQUIREMENTS: 1. Graduate of an accredited School of Nursing with current RN licensure in the state in which employment occurs is required. 2. One year of long term care clinical nursing experience is required. 3. Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. 4. Experience with basic computer technology. 5. This position requires that the employee is able to read, write, speak and understand the spoken English language to ensure the safety and wellbeing of our patients and visitors at the work site when responding to their medical and physical needs. 6. Maintains current BLS/CPR certification (excluding ALFs/ILFs). Position Type: Full Time Req ID: 287827 Center Name: Magnolia Ridge Center

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Regional Clinical Marketing Liaison (RN Or RT)

Rehab Liaison- Clinical License Or Healthcare Sales Required

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Principal Field Clinical Representative, Clinical Solutions Rhythm - Birmingham, AL Area Job

Field Clinical Representative II, Clinical Solutions Rhythm - Birmingham, AL Area Job

Clinical Solutions MD

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Clinical Reimbursement Coordinator (Full Time)

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