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Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
Remote working/work at home options are available for this role.
POSITION SUMMARY/RESPONSIBILITIES Serves as member of health care team that provides specialized health care including preventive care and on-going health maintenance for selected groups of patients.
Functions in a variety of settings ranging from ambulatory to inpatient.
Participates in the care of well, acutely ill and chronically ill patients.
EDUCATION A Registered Professional Nurse who is prepared for advanced nursing practice by virtue of knowledge and skills obtained through an accredited post basic or advanced educational program of study acceptable to the Board of Nurse Examiners.
A Master's degree in nursing is preferred.
Must be a participating Medicare provider or eligible to obtain a Medicare provider number.
Three years of nursing experience is required and two years of advanced practice is preferred.
LICENSURE/CERTIFICATION Must be currently licensed as a Registered Nurse in Texas and credentialed by the State to practice as an Advanced Nurse Practitioner.
Must maintain current AHA BLS or higher in accordance with Medical-Dental staff bylaws.
Prescriptive authority is required.
Valid DEA number must be obtained within 90 days of hire.
Certification by a national nursing body is required.
Remote working/work at home options are available for this role.
POSITION SUMMARY/RESPONSIBILITIES Counsels and assists patients and their families with personal and environmental difficulties which predispose illness or hinder the patient from receiving maximum benefits from medical care.
Acts as a therapeutic agent as a member of multi-disciplinary health and mental health teams.
EDUCATION/EXPERIENCE Master's degree in Social Work from a school accredited by the Council on Social Work Education is required.
One year's post master's degree experience in a health care setting is preferred.
LICENSURE Current state licensure from the Texas Department of Human Services is required.
POSITION SUMMARY/RESPONSIBILITIES Serves as a member of the mental health care team that provides specialized health care for selected groups of patients in the Adult Detention Center.
Participates as a part of a multidisciplinary team that includes medical and mental health.
Actively supports and adheres to the University Health policies and procedures.
Ensures efficient, appropriate and adequate mental health care is administered to incarcerated individuals in the Bexar County Adult Detention Center.
Supports and adheres to University Health (UH) and Detention Health Care Services (DHCS) – policies and procedures.
Demonstrates behaviors consistent with UH mission, vision, and values.
Promotes excellent internal and external customer relations.
EDUCATION A Registered Professional Nurse who is prepared for advanced nursing practice by virtue of knowledge and skills obtained through an accredited post basic or advanced educational program of study acceptable to the Board of Nurse Examiners.
A Master's degree in nursing is preferred.
Three years of nursing experience is required and two years of advanced practice is preferred.
Certification by a national nursing body is recommended.
LICENSURE Must be currently licensed as a Registered Nurse in Texas and credentialed by the State to practice as a Nurse Practitioner.
Prescriptive authority is required.
Remote working/work at home options are available for this role.
POSITION SUMMARY/RESPONSIBILITIES
Provides basic leadership skills for assigned patients, collaborates with other departments and begins process of proactive thinking when implementing the plan of care. Serves as mentor to the staff nurse and ancillary personnel; receives mentoring from Staff Nurse II and III; and Patient Care Coordinator.
EDUCATION/EXPERIENCE
Minimum of one year experience required. Verification of course completion in accordance with all American Heart Association Basic Cardiac Life Support and Health Care Provider guidelines is required. BSN highly preferred.
LICENSURE/CERTIFICATION
Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. Must have a current AHA BLS Healthcare Provider or AHA BLS Instructor Provider card.
Remote working/work at home options are available for this role.
Provides direct and indirect nursing care to patients in the Ambulatory setting in accordance with UH policies and standards.
Supports and promotes University Health values to ensure patient/guest relations.
Performs the nursing process in a safe therapeutic manner in a designated clinic setting.
Maintains, facilitates and promotes department policies and standards.
At least one year experience in direct patient care is preferred.
Current American Heart Association, Basic Cardiac Life Support and Healthcare Provider card required.
ACLS certification may be required based on site location.
Various certifications may be required based on location site.
Must possess a current license to practice Vocational Nursing in the State of Texas.
Remote working/work at home options are available for this role.
Provides telephonic assessments of members’ medical, psychosocial, physical, and spiritual needs. Utilizes completed UAS-NY assessments to develop a Person-Centered Service Plan (PCSP).
Responds to changes in members’ condition/sentinel events (i.e. level of care changes, changes in family support, changes in housing, etc.) by revising the PCSP and communicating changes with interdisciplinary care team and PCP.
Responds to requests for service within Medicare/Medicaid regulated time frames utilizing appropriate correspondence as per DOH/CMS regulations and departmental workflows.
Participates in and presents cases at the Interdisciplinary Care Team meetings to discuss any changes in member’s condition/sentinel events (i.e. level of care changes, changes in family support, changes in housing, etc.) identified during assessment process.
Collaborates with interdisciplinary care team members, such as Primary Care Physician, Social Worker, Specialists, Hospice/Palliative team, and Chief Medical Director when complex social/medical focus areas are identified during the assessment/care planning process as per unit workflows.
Educates members on Advanced Directives/Health Care Proxy/Power Of Attorney (POA) and helps to facilitate the completion of such documentation.
Bachelor’s degree social work or related field required, MSW or LMSW preferred.
Minimum three to five years clinical social experience in long term care, managed care, home care, geriatrics or hospice preferred.
Prior experience in an interdisciplinary service delivery environment preferred.
Working knowledge of Medicare and Medicaid regulations preferred.
Prior experience in an interdisciplinary service delivery environment preferred.
Current LMSW in New York State preferred.
The Registered Nurse – Home Health is responsible for providing and documenting skilled nursing care in accordance with the developed care plan and physicians’ orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.
Schedule:
Full-Time, 3 days a week.
Saturday & Sunday, plus choice of third day being either Friday or Monday.
Territory: All communities within a 30 mile radius of Rochester.
Essential Job Functions:
- Develop a plan of care through physician orders, client input, and nursing assessment to include medical interventions and measurable goals and outcomes.
- Educate clients and their family members based on client’s specific needs.
- Properly orient and train primary caregivers to ensure the most optimal functioning level for each client.
- Coordinate the continuum of hands on client care through documentation and timely communication with the client's physician and other caregivers.
- Provide care in patients home using a variety of skills such as phone triage, patient education, observation/assessment, wound care, infusions, catheter care, PICC line dressing changes etc.
Aveanna Healthcare Offers:
- 401(k) with match
- Health, Dental and Vision Benefits
- Tuition Discounts and Reimbursement
- PTO, Sick Time, and Paid Holidays
Requirements:
- An active RN License in the state of application
- Valid CPR
Preferred:
- Medicare Skilled Nursing experience
- Basic understanding of Oasis
- 1-year RN experience in a health care setting
HHH
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
Notice for Job Applicants Residing in California
Notice for Job Applicants Residing in Florida
Remote working/work at home options are available for this role.
We are looking for an Occupational Therapist (OT) to join our team! You will utilize your clinical expertise to assess, teach, and deliver therapy interventions and treatment directed by the Physician as established in the home health plan of care. You will collaborate with interdisciplinary team members, receiving and providing pertinent updates to optimize patient well-being.
Schedule: Monday - Friday full-time visits for Clarke, Fredrick and Warren county communities
Essential Job Functions:
- Perform initial and ongoing assessments to evaluate mobility, coordination, strength and current level of function.
- Responsible for administration, evaluation, and interpretation of tests and measurements to determine functional goals and outcomes.
- Provide a written evaluation and plan of care defining occupational therapy needs, goals, progress and expected outcomes.
- Delivery of occupational therapy services to comply with prescribed physician orders.
- Maintains plan of care by performing timely documentation of client performance, modifying goals and treatment as needed, and determine discharge care plans as appropriate.
- Responsible for discharge planning, including collaborating and educating the patient and his/her caretakers on home exercise plan to follow discharge.
- Participates in coordination of services with health care team, physicians, parent/guardians, nurses, etc.
- Documents according to policy and procedure and requires minimal supervision or instruction.
- Documents effectively resulting in no technical or clinical denials subsequent to review of documentation by payers
- Maintain effective communication between staff, healthcare team members and family. Serve as a resource consultant for clinical staff.
- Supervises other personnel (OTA, HHA) as applicable.
- Completes OASIS assessments where allowed by state professional practice and regulation.
Requirements:
- Degree in Occupational Therapy from an accredited university/program.
- Current, unrestricted state license as an Occupational Therapist in the state of practice
- Valid CPR and Drivers License
Preferred:
- Strong organization and communication skills
- Attention to detail
- Time management
- Proven relationship-builder
- Experience in Home Health Therapy and completion of OASIS documentation
HHH
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
Notice for Job Applicants Residing in California
Notice for Job Applicants Residing in Florida
Remote working/work at home options are available for this role.
We are looking for an Occupational Therapist (OT) to join our team! You will utilize your clinical expertise to assess, teach, and deliver therapy interventions and treatment directed by the Physician as established in the home health plan of care. You will collaborate with interdisciplinary team members, receiving and providing pertinent updates to optimize patient well-being.
Schedule: Full-Time (22.5 points/30 hours) visits Monday- Friday
Territory: Austin, Brownsdale, Hayfield, Stewartville, Dexter, and potentially Rochester depending on patient need
Essential Job Functions:
- Perform initial and ongoing assessments to evaluate mobility, coordination, strength and current level of function.
- Responsible for administration, evaluation, and interpretation of tests and measurements to determine functional goals and outcomes.
- Provide a written evaluation and plan of care defining occupational therapy needs, goals, progress and expected outcomes.
- Delivery of occupational therapy services to comply with prescribed physician orders.
- Maintains plan of care by performing timely documentation of client performance, modifying goals and treatment as needed, and determine discharge care plans as appropriate.
- Responsible for discharge planning, including collaborating and educating the patient and his/her caretakers on home exercise plan to follow discharge.
- Participates in coordination of services with health care team, physicians, parent/guardians, nurses, etc.
- Documents according to policy and procedure and requires minimal supervision or instruction.
- Documents effectively resulting in no technical or clinical denials subsequent to review of documentation by payers
- Maintain effective communication between staff, healthcare team members and family. Serve as a resource consultant for clinical staff.
- Supervises other personnel (OTA, HHA) as applicable.
- Completes OASIS assessments where allowed by state professional practice and regulation.
Aveanna Healthcare Offers:
- 401(k) with match
- Health, Dental and Vision Benefits
- Tuition Discounts and Reimbursement
- PTO, Sick Time, and Paid Holidays /
Requirements:
- Degree in Occupational Therapy from an accredited university/program.
- Current, unrestricted state license as an Occupational Therapist in the state of practice
- Demonstrated proficiency in clinical assessments, documentation and compliance with policies and procedures
- Valid CPR, Drivers License and proof of automobile insurance
HHH
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
Notice for Job Applicants Residing in California
Notice for Job Applicants Residing in Florida
Remote working/work at home options are available for this role.
