3 Carson Valley Medical Center jobs in Minden

Company :

Highmark Inc.

Job Description :

JOB SUMMARY

This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The incumbent ensures compliance to NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member of the multidisciplinary team for case and disease management. They will advise the multidisciplinary team on cases, particularly high-risk cases, through the team structure. Additionally, the incumbent may be assigned special projects to help support and improve the care of our members

ESSENTIAL RESPONSIBILITIES

• Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer to peer discussions, to determine medical necessity and appropriateness. Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned. Compose clear and concise rationales for member and provider determination notifications all while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.). Ensure that all aspects of the medical management process are consistent with community standards of care.

• Participate as a member of the CMDM multidisciplinary team. Attend huddles and grand rounds. Advise multidisciplinary team on cases that require physician expertise.

• Participate in protocol and guidelines development to ensure consistency in the review process.

• Actively manage projects and/or participate on project teams that require a physician subject matter expert.

• Other duties as assigned.

EDUCATION

Required

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Substitutions

• None

Preferred

• Master's Degree in Business Administration/Management or Public Health

EXPERIENCE

Required

• 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)

Preferred

• 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry

LICENSES AND CERTIFICATION

Required

• Medical Doctor or Doctor of Osteopathic Medicine (DO)

• Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards

• Active medical state licensure required. Additional specific state licensure(s) may be required based on business need.

Preferred

• None

SKILLS

• Critical Thinking

• Case Management

• Customer Service

• Oral & Written Communication Skills

• Collaboration

• Listening

• Telephone Skills

• General Computer Skills

• Clinical Software

• Managed Care

Language (Other than English)

None

Travel Required

0% - 25%

PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Occasionally

Travel regularly from the office to various work sites or from site-to-site

Rarely

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required

No

Lifting: up to 10 pounds

Constantly

Lifting: 10 to 25 pounds

Rarely

Lifting: 25 to 50 pounds

Rarely

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company's Handbook of Privacy Policies and Practices and Information Security Policy.

Furthermore, it is every employee's responsibility to comply with the company's Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Pay Range Minimum:

$170,000.00

Pay Range Maximum:

$352,500.00

Base pay is determined by a variety of factors including a candidate's qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.

We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.

For accommodation requests, please contact HR Services Online at

California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Req ID: J267780

PURPOSE AND SCOPE:

Supports FMCNA’s mission, vision, core values and customer service philosophy.  Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.

Functions as part of the hemodialysis health care team in providing safe and effective dialysis therapy for patients under the direct supervision of a licensed nurse in accordance with FMCNA policies, procedures, and training and in compliance with regulations set forth by the corporation, state, and federal agencies. Responsible for the setup and operation of hemodialysis machines.  Assist in the maintenance of a safe and clean working environment. Supports the FMCNA commitment to the Quality Enhancement Program (QEP) and CQI Activities, including those related to patient satisfaction and actively participates in process improvement activities that enhance the likelihood that patients will achieve the FMC Quality Enhancement Goals (QEP).

DUTIES / ACTIVITIES:

CUSTOMER SERVICE:

• Responsible for driving the FMS culture through values and customer service standards.
• Accountable for outstanding customer service to all external and internal customers.
• Develops and maintains effective relationships through effective and timely communication.
• Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.

PRINCIPAL RESPONSIBILITIES AND DUTIES

PATIENT CARE:

• Assist other health care members in providing patient specific detailed education regarding adequacy measures where appropriate - Online Clearance Monitoring (OLC), Adequacy Monitoring Program (AMP), Urea Kinetic Modeling (UKM), and regarding disease process/access.
• Welcome assigned patients and inquire as to their well-being since their last treatment. Report any complaints or observations to the nurse supervisor.
• Evaluate vascular access for patency and report any unusual findings to nurse supervisor.
• Obtain necessary pre and post treatment vital signs and weight.  Report unusual findings to nurse supervisor.
• Perform vascular access evaluation pre-treatment and report unusual findings to nurse supervisor.
• Perform vascular access cannulation and report any difficulties in cannulation or unusual findings to nurse supervisor.
• Perform administration of Heparin as delegated or as allowed by state law. 
• Initiate dialysis treatment according to prescribed orders including blood flow (QB) and dialysate flow (QD).
• Evaluate intradialytic problems and provide intervention as prescribed by physician order or as directed.
• Monitor patients’ response to dialysis therapy and report any unusual findings to nurse supervisor.
• Obtain vital signs prior to reinfusion; perform all relevant functions necessary for the discontinuation of treatment - document.
• Discontinue dialysis treatment according to established procedures,
• Evaluate patient prior to termination of venous access - standing & sitting blood pressure.
• Obtain Hemostasis and apply appropriate dressings.  
• Evaluate the patient for prior to discharge and report any unusual findings to nurse supervisor.
• Perform and record Pre and Post dialysis evaluation, weight and vital signs with initial identification.
• Responsible for calculating and entry of individual patients’ dialysis machine programming for Ultrafiltration (UF) goal; treatment time; Sodium (Na) modeling; and UF modeling as prescribed.
• Responsible for ensuring appropriate safety alarms are enabled, including Narrow Venous Limits (NVL) 160.
• Record accurate and timely information regarding vital signs and treatment parameters onto the Hemodialysis Treatment Sheet with initial identification.
• Responsible for accurate documentation of information related to patient treatment including completion of Hemodialysis Treatment Sheet and, if applicable, progress notes.
• Report any significant information and/or change in patient condition directly to the nurse supervisor. 
• Observe patient, and conduct machine safety checks according to facility policy.  Report any change or unusual findings to the nurse supervisor.
• Perform and document any intervention for unusual patient status and document patients' response to intervention.
• Evaluate patients’ vascular access during treatment including arterial and venous monitoring pressures, provide appropriate intervention as needed, document and report any unusual findings to the nurse supervisor.
• Obtain all prescribed laboratory testing and prepare specimens for collection.

MAINTENANCE/TECHNICAL:

• Maintain environmental integrity and aesthetics - ensure all areas are safe and clean.
• Clean and disinfect dialysis machine surface, chair, equipment, and surrounding area between treatments according to facility policy.
• Conduct all tasks necessary for preparation for dialysis treatment and document where appropriate.
• Perform all required pretreatment dialysis machine alarm testing including Pressure Holding (PHT).
• Initiate Solution Delivery System (SDS) system. 
• Ensure that all blood spills are immediately cleaned with appropriate disinfectant according to facility policy.
• Prepare, organize, and efficiently utilize supplies and equipment to prevent wastage.

CLERICAL & ADMINISTRATIVE:

• Complete and document ongoing participation in Continuous Quality Improvement (CQI) activities. 
• Enters all treatment data into the designated clinical application accurately and in a timely manner.
• Review treatment sheets for completeness, ensure nursing signatures are documented, and ensure omitted entries are completed or corrected where appropriate.
• Prepare initial patient chart for admission and compile paperwork for appropriate placement in chart.
• Prepare lab requisitions for prescribed or stat Lab specimens according to laboratory destination.
• Collect, label, appropriately prepare and store lab samples according required laboratory specifications.
• Ensure collection of lab specimens by appropriate lab courier.

OTHER:

• Perform additional duties as assigned.

ADDENDUM FOR PATIENT CARE TECHNICIANS WORKING IN THE HOME PROGRAMS (NOT HOME ASSIST):

Assisting the HT RN:

• May assist HT RN on Home Visit as directed
• Reinforces  PD / HHD education under supervision of qualified HT RN
• Schedules and contacts patients regarding appointments
• Weigh patient and obtain vital signs
• Collect treatment records and review for completion. Notify RN of incomplete / missing records.
• Cleaning and prepping treatment room; prep charts
• Preparing lab tubes and requisitions & assisting with lab draw days both pre and post draw (PCT certified phlebotomy or per state regulations)
• Clerical duties as assigned (faxing, mailing to physician offices etc.)
• Obtain home hemo water sampling as directed by the HT RN
• Set-up of the home hemo machine and PD Cycler.
• Assist with exit site care when directed by HT RN.
• Warm dialysate solution when directed by the HT RN
• Draw dialysate solution for testing as directed by the HT RN
• Creates and sends patient reminders (supply inventory for order, Kt/V collection, bringing meds to clinic visit for review)
• Assembles/breaks down charts/thins charts
• Maintains logs as directed and applicable
• Inventory of Home Program
• Maintains par levels of home department supplies
• Files home patient packing slips/invoices
• Inventory for Patients
• Assists patient with supply management and contacting customer service

PHYSICAL DEMANDS AND WORKING CONDITIONS:

The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.  Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Employees are required to take the Ishihara’s Color Blindness test as a condition of employment. Note that: Failing the Ishihara Test Blindness does not preclude employment. The Company will consider whether reasonable accommodations can be made.

Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians.  The position requires travel between assigned facilities and various locations within the community.  Travel to regional, Business Unit and Corporate meetings may be required.

The work environment is characteristic of a health care facility with air temperature control and moderate noise levels.  May be exposed to infectious and contagious diseases/materials

The position provides direct patient care that regularly involves heavy lifting and moving of patients, and assisting with ambulation.  Equipment aids and/or coworkers may provide assistance.  This position requires frequent, prolonged periods of standing and the employee must be able to bend over. The employee may occasionally be required to push and/or pull equipment, exerting up to 15 pounds of force.  The employee may be required to lift and to lower solutions on a frequent basis of up to 30 lbs., and on an occasional lift basis up to 40 lbs., as high as 5 feet.  There is a two-person assist program and "material assist” devices for the heavier items.

EDUCATION

• Center for Medicaid/Medicare Services (CMS)-approved state and/or national certification or High School diploma or G.E.D. and must meet certification requirements within the required state or CMS timeline.
• All appropriate state licensure, education and training (if any) required. 

EXPERIENCE AND REQUIRED SKILLS

• Previous patient care experience in a hospital setting or related facility preferred.
• Continued employment is dependent on successful completion of the FMCNA dialysis training program and successful completion of CPR certification.

EO/AA Employer: Minorities/Females/Veterans/Disability/Sexual Orientation/Gender Identity

Fresenius Medical Care North America maintains a drug-free workplace in accordance with applicable federal and state laws.