Nucleus Healthcare is seeking a Respiratory Therapist  offering to join a devoted patient care organization in Milwaukee, WI.  

Job Title: Respiratory Therapist 

Shift Details: Night Shift 3x12s

Job Description:
Respiratory Therapist provides quality patient care, providing intensive respiratory care and patient transport into and out of the facility as medically prescribed, within the scope of professional license and with minimal supervision. Evaluates patient and recommends a treatment plan.

Performs chest physiotherapy by operating various equipment to promote secretion clearance.

Performs suctioning of the patient by various methods (oropharyngeal, nasal and tracheal).

Performs oximetry and capnography monitoring according to policy.

Performs routine review of patient's chest x-rays to determine need for further evaluation.

Performs 12-Lead EKG and basic arrhythmia recognition.

Performs pulmonary function studies according to policy (i.e. NIF, VC etc.)

Assists with procedures relating to respiratory care according to policy (i.e. Bronchoscopy, Perc Trachs, Chest Tube placement, etc.).

Performs adequate drainage of chest via PleurX catheter or similar device where applicable.

Performs tracheostomy care according to policy, including insertion and removal of tracheostomy tubes (emergent and non-emergent).

Performs arterial puncture according to policy and is able to determine efficiency of ventilation, as well as monitoring, recording and reporting of test results.

For hospitals with moderate complexity labs: Follows all policies and procedures related to laboratory testing including: specimen handling, use of equipment, documentation and reporting of results, quality controls and maintenance to include: Pre-analytic, Analytic, and Post-analytic phases of testing.

Performs cardiopulmonary resuscitation according to BLS and ACLS guidelines.

Performs insertion and removal of endotracheal tubes via free hand technique and/or video laryngoscope system.

Performs set-up & self-test on all ventilatory equipment as required and operates, maintains and monitors mechanical ventilation on various types of equipment.

Assists in facilitating preventative maintenance and repair of equipment as needed.

Records all pertinent information of treatments, and patient response to treatments on respiratory care records and patient chart (including pre and post-assessment according to policy).

Communicates with attending and pulmonary physician's concerning the efficiency of therapy administered to the patient.

Reports all necessary information in hands-off communication during walking rounds for shift-to-shift.

Maintains accurate respiratory therapy charging, including data entry, verification and correction of errors.

Performs other duties as assigned.

Qualifications:
Current state licensure required
BLS certification required prior to first shift
ACLS required prior to first shift
Must possess "Active" CRT or RRT credential from the National Board of Respiratory Care (NBRC) or state equivalent.
Minimum two (2) years bedside clinical experience

Nucleus Healthcare is a staffing and recruitment agency partnering with top-tier facilities and organizations to deliver quality candidates looking for meaningful employment. We have permanent placement and long-contract jobs nationwide in nursing, allied health, healthcare operations, and hospitality. Our vision of redefining the way healthcare does business is what fuels our mission to empower the people who power healthcare. 

We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status, employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. 

The Registered Nurse (RN) maintains the delivery of quality care by assuring the nursing care plan is followed. The RN supervises Licensed Practical Nurses, Certified Nursing Assistants, and orientees.

Bedside Acute Care RN
Day Shift – 3x12s
Location: Kingsport - Bristol, TN

Complete Description:
Embraces  Core Values of the Company:
 • We deliver superior quality in all that we do.
 • We treat others as they would like to be treated.
 • We are results oriented and achieve our objectives.
 • We are team players.
 • We are resourceful in overcoming obstacles.
 

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
 • Safe Patient Handling
 • Materials Handling
 • Infectious Diseases
 • Slips/Trips and Falls
 • Work Environment
 
Follows all hospital guidelines outlining standards of personal appearance, attendance and punctuality.
 
Based on the Competency Program established for direct care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

JOB-SPECIFIC DUTIES/COMPETENCIES
Performs a nursing assessment on all patients within 8 hours of admission. The data collected forms the basis of an individualized plan of care. Identifies teaching needs and goals related to the diagnosis of each patient from the nursing admission assessment and by collaborating with patient/family and the Interdisciplinary team.
 

Provides patient information and status in a timely manner for the Initial Team Conference and for Re-evaluation Team Conferences on a weekly basis. Responsible and accountable for accurate, succinct and timely documentation of all assessments, interventions and patient’s response in the medical record in accordance with policy.

Participates in the patient rehabilitation program on an assigned unit. Is responsible and accountable for direct patient care by utilizing the nursing process of assessing, planning, implementing and evaluating patient care with a priority on the education of the patient/family/significant other based on the health care needs identified. Uses a positive and encouraging approach to achieve patient goals and quality outcomes. Initiates discharge planning on all patients from the day of admission. Initiates patient teaching in anticipation of the discharge date.
 

Communicates all pertinent information regarding changes in patient’s status from one care provider to another, to support continuity of care and patient safety. This includes the attending physician and the Charge Nurse. Seeks consultation from more senior nursing staff in support of complex clinical decision-making.
 

Provides direction, training and supervision of ancillary nursing personnel by utilizing problem solving techniques in decision making, organizing, setting priorities and using time effectively. Delegates appropriately.
 

Provides for and assures personal and environmental safety in accordance with hospital and nursing policies and procedures. Positively contributes to the functioning of the unit by providing calm direction and reassurance to ancillary staff, other departments, patients and families. Participates in team building activities on the unit to create a positive and efficient work environment.

Maintains communication with manager and senior nursing staff related to service needs such as necessary supplies, equipment (including repairs) and clinical training in order to effectively complete assigned duties. Provides care in a cost-effective manner while promoting quality patient outcomes, monitors supplies and charges. Assumes charge responsibility following orientation period as requested. Identifies and initiates own professional growth, actively pursuing professional development through continuing education and self-study.
 

Prioritizes activities and plans for effective use of time and staff in meeting patient needs.
Performs other duties as requested.

 

Nucleus Healthcare is seeking an Certified Nursing Assistant for a 13-week contract assignment at a health system in Jackson, TN

Title: Certified Nursing Assistant
Shift Time Type: Days
Hours Per Week: 36 (3x12s)

Embraces the Select Medical Way and Core Values of the Company:
• We deliver superior quality in all that we do.
• We treat others as they would like to be treated.
• We are results oriented and achieve our objectives.
• We are team players.
• We are resourceful in overcoming obstacles.

One of our 4 Key organizational results is to Keep our Patients and Each Other Safe:
Select Medical is an organization where patient safety and employee safety are a priority. This focus on safety is applicable to all business lines and levels of care. To those of us who work for Select Medical, these are more than words. Putting safety first allows us to provide superior care for our patients and provides a work environment where each employee is expected to take care of themselves and each other by making safe choices, using equipment provided, identifying work place hazards, adhering to safety policies and procedures and reporting risks or hazards as soon as possible.

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
• Safe Patient Handling
• Materials Handling
• Infectious Diseases
• Slips/Trips and Falls
• Work Environment

Follows all facility guidelines outlining standards of personal appearance, attendance and punctuality.
Based on the Competency Program established for indirect care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

Demonstrate knowledge and proficiency of menu management system.
Prepare, assemble, deliver and retrieve patient menus/ menu selections according to prescribed diets.
Assist patients in completing menu selections compliant with prescribed diet. Offer alternative menu, as allowed on prescribed diet and in accordance with food allergies, food sensitivities, cultural, ethnic, and religious preferences.
Update and/or validate diet changes in the patient menu system with the most current diet order.
Update and/or validate menu and nourishment labeling is compliant with most current diet order. Create, print and place menu labels as needed.
Communicates patient care and food service issues to the department.
Print and distribute reports, such as meal tallies, patient diet lists and nourishment lists.
Follow HIPAA and Joint Commission guidelines in accordance with organizational and departmental policies.
Perform clerical assignments in Food & Nutrition office including faxing, answering phones, filing, photocopying, etc. Maintains organization and efficiency of department office. Follows up with inquiries and requests in a timely and appropriate manner.
Maintain proper levels of office and menu supplies.
Attend in-services and other departmental related meetings.
Assists trayline, food service aides or catering as needed.
Performs other duties as requested

The Registered Nurse (RN) maintains the delivery of quality care by assuring the nursing care plan is followed. The RN supervises Licensed Practical Nurses, Certified Nursing Assistants, and orientees.

Bedside Acute Care RN
Night Shift – 3x12s
Location: Bristol, Tennessee

Complete Description:
Embraces  Core Values of the Company:
 • We deliver superior quality in all that we do.
 • We treat others as they would like to be treated.
 • We are results oriented and achieve our objectives.
 • We are team players.
 • We are resourceful in overcoming obstacles.
 

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
 • Safe Patient Handling
 • Materials Handling
 • Infectious Diseases
 • Slips/Trips and Falls
 • Work Environment
 
Follows all hospital guidelines outlining standards of personal appearance, attendance and punctuality.
 
Based on the Competency Program established for direct care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

JOB-SPECIFIC DUTIES/COMPETENCIES
Performs a nursing assessment on all patients within 8 hours of admission. The data collected forms the basis of an individualized plan of care. Identifies teaching needs and goals related to the diagnosis of each patient from the nursing admission assessment and by collaborating with patient/family and the Interdisciplinary team.
 

Provides patient information and status in a timely manner for the Initial Team Conference and for Re-evaluation Team Conferences on a weekly basis. Responsible and accountable for accurate, succinct and timely documentation of all assessments, interventions and patient’s response in the medical record in accordance with policy.

Participates in the patient rehabilitation program on an assigned unit. Is responsible and accountable for direct patient care by utilizing the nursing process of assessing, planning, implementing and evaluating patient care with a priority on the education of the patient/family/significant other based on the health care needs identified. Uses a positive and encouraging approach to achieve patient goals and quality outcomes. Initiates discharge planning on all patients from the day of admission. Initiates patient teaching in anticipation of the discharge date.
 

Communicates all pertinent information regarding changes in patient’s status from one care provider to another, to support continuity of care and patient safety. This includes the attending physician and the Charge Nurse. Seeks consultation from more senior nursing staff in support of complex clinical decision-making.
 

Provides direction, training and supervision of ancillary nursing personnel by utilizing problem solving techniques in decision making, organizing, setting priorities and using time effectively. Delegates appropriately.
 

Provides for and assures personal and environmental safety in accordance with hospital and nursing policies and procedures. Positively contributes to the functioning of the unit by providing calm direction and reassurance to ancillary staff, other departments, patients and families. Participates in team building activities on the unit to create a positive and efficient work environment.

Maintains communication with manager and senior nursing staff related to service needs such as necessary supplies, equipment (including repairs) and clinical training in order to effectively complete assigned duties. Provides care in a cost-effective manner while promoting quality patient outcomes, monitors supplies and charges. Assumes charge responsibility following orientation period as requested. Identifies and initiates own professional growth, actively pursuing professional development through continuing education and self-study.
 

Prioritizes activities and plans for effective use of time and staff in meeting patient needs.
Performs other duties as requested.

 

The Registered Nurse (RN) maintains the delivery of quality care by assuring the nursing care plan is followed. The RN supervises Licensed Practical Nurses, Certified Nursing Assistants, and orientees.

Bedside Acute Care RN
Night Shift – 3x12s
Location: Youngstown, OH 

Complete Description:
Embraces  Core Values of the Company:
 • We deliver superior quality in all that we do.
 • We treat others as they would like to be treated.
 • We are results oriented and achieve our objectives.
 • We are team players.
 • We are resourceful in overcoming obstacles.
 

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
 • Safe Patient Handling
 • Materials Handling
 • Infectious Diseases
 • Slips/Trips and Falls
 • Work Environment
 
Follows all hospital guidelines outlining standards of personal appearance, attendance and punctuality.
 
Based on the Competency Program established for direct care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

JOB-SPECIFIC DUTIES/COMPETENCIES
Performs a nursing assessment on all patients within 8 hours of admission. The data collected forms the basis of an individualized plan of care. Identifies teaching needs and goals related to the diagnosis of each patient from the nursing admission assessment and by collaborating with patient/family and the Interdisciplinary team.
 

Provides patient information and status in a timely manner for the Initial Team Conference and for Re-evaluation Team Conferences on a weekly basis. Responsible and accountable for accurate, succinct and timely documentation of all assessments, interventions and patient’s response in the medical record in accordance with policy.

Participates in the patient rehabilitation program on an assigned unit. Is responsible and accountable for direct patient care by utilizing the nursing process of assessing, planning, implementing and evaluating patient care with a priority on the education of the patient/family/significant other based on the health care needs identified. Uses a positive and encouraging approach to achieve patient goals and quality outcomes. Initiates discharge planning on all patients from the day of admission. Initiates patient teaching in anticipation of the discharge date.
 

Communicates all pertinent information regarding changes in patient’s status from one care provider to another, to support continuity of care and patient safety. This includes the attending physician and the Charge Nurse. Seeks consultation from more senior nursing staff in support of complex clinical decision-making.
 

Provides direction, training and supervision of ancillary nursing personnel by utilizing problem solving techniques in decision making, organizing, setting priorities and using time effectively. Delegates appropriately.
 

Provides for and assures personal and environmental safety in accordance with hospital and nursing policies and procedures. Positively contributes to the functioning of the unit by providing calm direction and reassurance to ancillary staff, other departments, patients and families. Participates in team building activities on the unit to create a positive and efficient work environment.

Maintains communication with manager and senior nursing staff related to service needs such as necessary supplies, equipment (including repairs) and clinical training in order to effectively complete assigned duties. Provides care in a cost-effective manner while promoting quality patient outcomes, monitors supplies and charges. Assumes charge responsibility following orientation period as requested. Identifies and initiates own professional growth, actively pursuing professional development through continuing education and self-study.
 

Prioritizes activities and plans for effective use of time and staff in meeting patient needs.
Performs other duties as requested.

 

The Registered Nurse (RN) maintains the delivery of quality care by assuring the nursing care plan is followed. The RN supervises Licensed Practical Nurses, Certified Nursing Assistants, and orientees.

Bedside Acute Care RN
Night Shift – 3x12s
Location: Jackson, MS

Complete Description:
Embraces  Core Values of the Company:
 • We deliver superior quality in all that we do.
 • We treat others as they would like to be treated.
 • We are results oriented and achieve our objectives.
 • We are team players.
 • We are resourceful in overcoming obstacles.
 

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
 • Safe Patient Handling
 • Materials Handling
 • Infectious Diseases
 • Slips/Trips and Falls
 • Work Environment
 
Follows all hospital guidelines outlining standards of personal appearance, attendance and punctuality.
 
Based on the Competency Program established for direct care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

JOB-SPECIFIC DUTIES/COMPETENCIES
Performs a nursing assessment on all patients within 8 hours of admission. The data collected forms the basis of an individualized plan of care. Identifies teaching needs and goals related to the diagnosis of each patient from the nursing admission assessment and by collaborating with patient/family and the Interdisciplinary team.
 

Provides patient information and status in a timely manner for the Initial Team Conference and for Re-evaluation Team Conferences on a weekly basis. Responsible and accountable for accurate, succinct and timely documentation of all assessments, interventions and patient’s response in the medical record in accordance with policy.

Participates in the patient rehabilitation program on an assigned unit. Is responsible and accountable for direct patient care by utilizing the nursing process of assessing, planning, implementing and evaluating patient care with a priority on the education of the patient/family/significant other based on the health care needs identified. Uses a positive and encouraging approach to achieve patient goals and quality outcomes. Initiates discharge planning on all patients from the day of admission. Initiates patient teaching in anticipation of the discharge date.
 

Communicates all pertinent information regarding changes in patient’s status from one care provider to another, to support continuity of care and patient safety. This includes the attending physician and the Charge Nurse. Seeks consultation from more senior nursing staff in support of complex clinical decision-making.
 

Provides direction, training and supervision of ancillary nursing personnel by utilizing problem solving techniques in decision making, organizing, setting priorities and using time effectively. Delegates appropriately.
 

Provides for and assures personal and environmental safety in accordance with hospital and nursing policies and procedures. Positively contributes to the functioning of the unit by providing calm direction and reassurance to ancillary staff, other departments, patients and families. Participates in team building activities on the unit to create a positive and efficient work environment.

Maintains communication with manager and senior nursing staff related to service needs such as necessary supplies, equipment (including repairs) and clinical training in order to effectively complete assigned duties. Provides care in a cost-effective manner while promoting quality patient outcomes, monitors supplies and charges. Assumes charge responsibility following orientation period as requested. Identifies and initiates own professional growth, actively pursuing professional development through continuing education and self-study.
 

Prioritizes activities and plans for effective use of time and staff in meeting patient needs.
Performs other duties as requested.

 

Local Only

Short Description: 

The Registered Nurse (RN) maintains the delivery of quality care by assuring the nursing care plan is followed. The RN supervises Licensed Practical Nurses, Certified Nursing Assistants, and orientees.

Bedside Acute Care RN
Day & Night Shift – 3x12s
Location: Newport News, VA 

Complete Description:
Embraces  Core Values of the Company:
 • We deliver superior quality in all that we do.
 • We treat others as they would like to be treated.
 • We are results oriented and achieve our objectives.
 • We are team players.
 • We are resourceful in overcoming obstacles.
 

Promotes Patient and Employee Safety – Focused on 10 Foot Circle of Safety and displays safety awareness in all of the below key areas:
 • Safe Patient Handling
 • Materials Handling
 • Infectious Diseases
 • Slips/Trips and Falls
 • Work Environment
 
Follows all hospital guidelines outlining standards of personal appearance, attendance and punctuality.
 
Based on the Competency Program established for direct care providers, possesses the skills and competencies necessary to perform job function in accordance with population served criteria.

JOB-SPECIFIC DUTIES/COMPETENCIES
Performs a nursing assessment on all patients within 8 hours of admission. The data collected forms the basis of an individualized plan of care. Identifies teaching needs and goals related to the diagnosis of each patient from the nursing admission assessment and by collaborating with patient/family and the Interdisciplinary team.
 

Provides patient information and status in a timely manner for the Initial Team Conference and for Re-evaluation Team Conferences on a weekly basis. Responsible and accountable for accurate, succinct and timely documentation of all assessments, interventions and patient’s response in the medical record in accordance with policy.

Participates in the patient rehabilitation program on an assigned unit. Is responsible and accountable for direct patient care by utilizing the nursing process of assessing, planning, implementing and evaluating patient care with a priority on the education of the patient/family/significant other based on the health care needs identified. Uses a positive and encouraging approach to achieve patient goals and quality outcomes. Initiates discharge planning on all patients from the day of admission. Initiates patient teaching in anticipation of the discharge date.
 

Communicates all pertinent information regarding changes in patient’s status from one care provider to another, to support continuity of care and patient safety. This includes the attending physician and the Charge Nurse. Seeks consultation from more senior nursing staff in support of complex clinical decision-making.
 

Provides direction, training and supervision of ancillary nursing personnel by utilizing problem solving techniques in decision making, organizing, setting priorities and using time effectively. Delegates appropriately.
 

Provides for and assures personal and environmental safety in accordance with hospital and nursing policies and procedures. Positively contributes to the functioning of the unit by providing calm direction and reassurance to ancillary staff, other departments, patients and families. Participates in team building activities on the unit to create a positive and efficient work environment.

Maintains communication with manager and senior nursing staff related to service needs such as necessary supplies, equipment (including repairs) and clinical training in order to effectively complete assigned duties. Provides care in a cost-effective manner while promoting quality patient outcomes, monitors supplies and charges. Assumes charge responsibility following orientation period as requested. Identifies and initiates own professional growth, actively pursuing professional development through continuing education and self-study.
 

Prioritizes activities and plans for effective use of time and staff in meeting patient needs.
Performs other duties as requested.

 

Nucleus Healthcare is seeking a passionate and experienced Credentialing Specialist to join our client's team in Des Peres, MO. 

Job Title: Credentialing Specialist 

EXPERIENCE
• Five years' experience in provider credentialing, privilege form development/management, or similar role.
• Credential Stream Experience
• Strong understanding of healthcare regulations and standards.
• Proficiency in provider credentialing and privileging software and tools.
• Excellent analytical and problem-solving skills.
• Strong communication and collaboration skills.
• Attention to detail and ability to manage multiples tasks/project simultaneously.

Job Summary:
The Provider Credentialing and Privileging Analyst will be responsible for designing and developing privilege forms for healthcare providers. This role requires a strong understanding of healthcare regulations, provider credentialing, and privilege form development processes. The ideal candidate will have excellent analytical skills, attention to detail, and the ability to collaborate effectively with various stakeholders.
Job Responsibilities and Requirements:
PRIMARY RESPONSIBILITIES
• Support the transition to CredentialStream credentialing software, to ensure a smooth implementation and adoption across facility
• Design, develop, and implement standardized privilege forms across multiple facilities for healthcare providers based on regulatory and organizational requirements.
• Provide analysis of current credentialing and privileging processes and forms.
• Provide data clean up in current system (ECHO) as needed.
• Actively support the transition to CredentialStream software, including data migration, process optimization, and approval workflow(s) to enhance efficiency and accuracy.
• Support the standardization of credentialing and privileging policies and procedures across facilities
• Assist in reviewing, developing, and updating policies to ensure alignment with current legal, accreditation, and regulatory standards (e.g., TJC, NCQA, CMS, state boards)
• Collaborate with administrative, clinical, and external teams to gather requirements and ensure forms meet the needs of all stakeholders.
• Maintain and update existing privilege forms/sets to reflect changes in regulations and organizational policies.
• Conduct thorough testing and validation of privilege forms and processes to ensure accuracy and compliance.
• Maintain industry trends and best practices in provider credentialing and privilege forms.
• Provide training and support staff on the changes/updates and use of new standardized privilege forms.
• Performs other duties as assigned.

EDUCATION:
• Bachelor’s degree in healthcare administration, information technology/related field, or equivalent combination of experience and education.

Local Contract Only

Nucleus Healthcare is seeking a dedicated and experienced NICU Nurse for a 13-week full-time contract position at a health system in Hopewell, New Jersey. 

 
Position Title: NICU RN – 8-Week Contract
Shift: Night Shift (7:00 PM – 7:30 AM)
Schedule: Every Other Weekend & Holiday
EMR: Cerner

The NICU RN delivers high-quality, safe, and compassionate care to neonatal patients by utilizing the nursing process: assessment, diagnosis, planning, implementation, and evaluation. This role requires collaboration, critical thinking, and strong communication skills to support both patients and their families throughout the continuum of care.

Nucleus Healthcare is seeking a dedicated and experienced Registered Nurse specializing in Case Management for a 13-week full-time contract position at a health system in Mesa, AZ. 

 

Job - RN Case Manager
Location - Mesa, AZ - Banner Rehab East
Shift - M-F (8 Hour/Day)
Pay - $50-$55/Hour

Follows all facility guidelines outlining standards of personal appearance, attendance and punctuality.
Identify the patient's problem or situation presently affecting the patient and/or families ability to adapt to or participate in their treatment plan.
Assist the patient and/or family in the utilization of all hospital resources to remove barriers to adjust to their healthcare situation.
Assists the patient and/or family to participate in the decision making of their individual plan of care and development of a safe discharge plan.
In collaboration with the interdisciplinary team, including the physician, the CM manages and directs a clinical plan of care to overcome barriers and assist the patient to achieve a safe and timely discharge to the next most appropriate lower level of care.
Interacts appropriately with patients according to age and level of understanding.
Refer patients and families to outside agencies for social problems unrelated to the health care situation as required by state regulation.
Informs DCM/CEO of all major conditions, subsequent changes, and emergency situations. Submits accurate and thorough work on time. Completes data collection and tabulation of statistical information as directed.
Follows correct company procedures when interacting with patients and families. Assures team and family conferences are conducted according to policy and procedure. Assures team conference reports are professional and appropriate in collaboration with clinical services.
Works cooperatively as a team member to identify and solve facility-wide needs and improve operations. Participates in scheduled meetings.
Assures medical necessity review criteria, as mandated by the QIO, is implemented for all admissions and continued stays.
Assures thorough and timely completion of utilization review and non-Medicare utilization.
Identify barriers to reaching a solution to the problem or situation defined above.
Stresses Payor/Referral satisfaction. Effectively interacts with patients, families, and visitors to enhance guest relations. Represents the facility in all contacts with other health professionals and the general public in a manner which enhances the facility’s reputation. Meets payor requirements by assuring all insurance certifications are timely. Assures payor/referral satisfaction with Case Management to promote repeat business. Assures team is notified immediately of payor requirements.
Maintains an up-to-date community resource system and assists patient and family in gaining knowledge of, and access to, appropriate services.
In collaboration with the Clinical Services Department, assures clinical documentation is in accordance with payor guidelines for reimbursement.
Works in collaboration with the clinical team and physicians to identify unnecessary appointments, tests and procedures in accordance with the patient’s plan of care.
Assures discharge planning evaluations are completed per policy and regulatory standards.
Maintains fiscal responsibilities by assuring appropriate levels of contract are being billed.
Completes Director of Case Manager reports/duties in their absence as instructed. Reviews insurance verification form to minimize risk.
Provides payor-friendly options to promote prompt payments while reducing facility's financial risks. Communicates any billing or payor concerns to CBO as needed. Assures thorough and timely completion of critical payor information in the MedHost commercial UR system. Submits accurate projections weekly of commercial to Corporate finance. Assures Billing and Reimbursement form is completed and signed if indicated. Reviews insurance verification form to minimize risk.
Assures all national and local contract requirements are identified and fulfilled.
Outlier Management: Demonstrates working knowledge, actively manages patients utilizing appropriate tools to optimize outcomes. Attends weekly meetings as indicated.
Document the plan of care and progress notes in the medical record as required by policy and state regulations.
Performs other duties as assigned.