Resource Specialist - NBMC (Per Diem, Day)

At Northbay Health, the Resource Specialist will perform a combination of duties designed to maximize the utilization of hospital resources and coordinate post-hospital care for patients in support of Inpatient Case Management. These comprehensive duties include communication and coordination with payers and outside agencies to assist with patient discharge and supporting IPCM accountabilities. The Resource Specialist at Northbay Healthcare must be able to demonstrate adherence to the department and system policies, procedures, quality assurance, guidelines and goals of the department and the organization. The Resource Specialist takes day to day direction for priorities from the Inpatient Case Management Supervisor or designee.

PRIMARY JOB DUTIES

- Maintains regular communication with Inpatient Case Managers (IPCM), Social Workers, appropriate management staff, outside agencies and other hospital departments.
- Prepares necessary paperwork for the Social Workers and IPCM.
- Provides support to the IPCM: faxing, copying charts, follow-up phone calls, Certification Entry, follow-up appointments, with documentation in Cerner and naviHealth per policies and procedures.
- Initiates and documents Advanced Directive paperwork with patients as directed.
- Initiates, documents, and tracks Important Message from Medicare, Observation Letters, and Anticipated Discharge Date in collaboration with IPCM.
- Interacts with review organizations, third party payers, and outside agencies to expedite resources for patient discharge plans and maximize hospital reimbursement for services provided.
- Documents denials, authorizations, and health plan updates in Cerner.
- Appropriately notifies Medical Auditor and/or Supervisor of authorization issues.
- Interacts with patients and/or families to provide resource options, as directed.
- Verifies insurance benefits and contracted agencies for patient care options post discharge.
- Coordinates post-hospital care (SNF, DME, Home Health, Crisis, etc.) in accordance with the interventions and discharge plan created by the IPCM.
- Maintains and updates resources on K drive and notifies Office Lead of updates.
- Attends and participates in patient care rounds, as appropriate.
- Upon the request of IPCM, produces and distributes all necessary correspondence.
- Produces necessary correspondence, including hospital transfer information, for the IPCM.
- Organizational standards for Joint Commission, Department of Human Services, Patient Safety, CMS Conditions of Participation, and the Department of Health will be met.
- Performs audits (i.e. Anticipated Discharge Date) as assigned.
- Performs special functions and other duties as assigned.

Education

- High school diploma preferred.
- Bachelor’s degree in science field, Medical Assistant or CNA certification preferred.

Experience

- One or more years of experience in a hospital or medical setting preferred.
- Knowledge of medical terminology required.
- Experience in utilization management, discharge planning, and/or social work preferred.

Skills

- Excellent organization and communication skills.
- Able to work independently and collaboratively.
- Organizes workload and sets priorities using good judgment.
- Able to handle multiple telephone calls and work with frequent interruptions.
- Takes initiative; identifies opportunities and follows through on appropriate issues.
- Good oral and written communication skills are required.
- Proficient in using copiers, fax machines, computers, and other general office equipment.
- Experience with Microsoft Word, Excel, and Outlook.
- PowerPoint, Cerner, and naviHealth preferred.

Interpersonal Skills

- Interacts with patients, staff and visitors in a pleasant, cooperative, and courteous manner.
- Ability to demonstrate caring, collaboration, competence, and communication behaviors by communicating effectively with patients/families, physicians, health care personnel, supervisory staff, and peers.
- Demonstrates open and honest communication.
- Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction.
- Demonstrates the willingness to research, learn, and obtain knowledge for the performance of the position.
- Demonstrates a courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner.
- Utilizes critical thinking, and applies sound clinical judgment and assessment skills for decision making.

Standards of Performance

- Demonstrate performance by adhering to established policies and procedures and exhibiting the defined characteristics associated with attendance and punctuality.

Physical Effort

- Attendance is an essential function of the job.
- The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
- Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.
- Requires some walking, periods of sitting and standing.
- Some stooping, bending, and twisting.
- Requires use of computer keyboard throughout the workday.

Hours of Work

- As assigned by IPCM Supervisor.
- Based on business needs.

Compensation:

- Hourly Salary Range: $34.88 - $42.41 (Offered hourly rate based on years of experience)
- Listed range includes 10% per diem differential