4 jobs found in Clinton, MS

Under broad direction from the Centralized Utilization Management Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves infant, pediatric, adolescent, young adult, adult and geriatric patients. Incumbent of this position is responsible for planning, developing, implementing and monitoring these facility-wide programs. Responsible to ensure cost effective and quality patient care by appropriate utilization of hospital resources. Performs highly responsible professional nursing and administrative work in accordance with established standards, criteria, procedures, rules, regulations and policies. of the agency.  Actively communicates with department heads to ensure compliance with these standards. Team 30% a. Completes all job requirements related to prospective, concurrent and retrospective case review and reporting quality issues identified during the utilization review process to department leaders.  b....

The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. Directs the utilization review of patient charts and treatment plans pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager of Clinical Services specializes in the review of information pertaining specifically to the assigned area (i.e.: Case Management, Geriatrics, Mental & Behavioral Health, Home Health). Most, but not all, of the accountabilities below may apply to each specific area. Evaluation and Analysis:...

The Patient Access Representative facilitates a welcome and easy access to the facility and is responsible for establishing an encounter for any patient who meets the guidelines for hospital service. The PAR ensures that all data entry is accurate, including demographic and financial information for each account. The PAR has numerous procedural requirements, including data elements, insurance verification, and authorization for services; collections for all patient portions including prior balances; and balancing of cash at shift end. The PAR communicates directly with patients and families, physicians, nurses, insurance companies, and third party payers. The PAR has the ability to, and serves as, team lead, lean Process improvement participant, new hire preceptor/mentor and/or auditor for regulatory and billing compliance.  Customer Service Effectively meets customer needs, builds productive customer relationships, and takes responsibility for customer satisfaction and loyalty....

This position is responsible for the day-to-day operations of the care management clinical staff under the general direction of the Care Management Director. The position will integrate knowledge, skills, and experiences to meet the needs of patients and families throughout the continuum of care. They rely on extensive experience and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected in order to lead and direct the work of others. 1. Assist the director of the department with support of clinical and administrative case management and social service roles through participation, problem solving and scheduling of staff in order to facilitate appropriate patient flow and services. Plans and updates in-service education programs for all case management staff annually. Conducts case review and high-risk screening evaluations weekly with staff. Performs weekly quality reviews and communicates findings to both staff and management team....