Clinical Resource Manager

Trinity Health•Boise, ID

4d•Onsite

About The Position

The Clinical Resource Manager provides hospital case management, utilization review, and discharge planning. Working collaboratively with patients, families, physicians, and other members of the healthcare team, the manager determines level-of-care needs beyond acute care, supports informed decisions, manages expectations, and helps ensure a smooth transition to the next level of care and services. The role also coordinates social services as appropriate and supports the hospital’s case management, utilization review, and discharge planning activities while adhering to departmental standards, policies, quality requirements, and regulatory compliance. The manager provides concurrent support to physicians and clinical team members for assigned patients. Through real-time communication with physicians, nursing, and ancillary caregivers, the role establishes treatment, cost, and transition targets and facilitates transition planning to support quality clinical and cost outcomes. This is a part-time, day-shift position in Boise, Idaho. The job posting also includes unrelated laboratory education and phlebotomy content, which does not correspond to the Clinical Resource Manager role.

Requirements

Current Idaho RN license. Nurses moving to Idaho from another compact state must apply for licensure by endorsement and change their primary state of residence to Idaho within 60 days of hire.
Provide licensure or proof of application for a secondary state within 90 days of hire.
Bachelor of Science in Nursing (BSN).
At least 2 years of varied hospital clinical experience.

Nice To Haves

Master’s degree.
Experience in case management, home health, and/or the insurance industry.

Responsibilities

Coordinate social services and case management with patient care, discharge planning, and home planning, collaborating with hospital departments, external service organizations, agencies, and healthcare facilities.
Screen and assess physician-assigned cases to determine medical necessity, patient status, and transition needs; reassess and modify transition needs as appropriate.
Conduct concurrent medical record reviews using established medical necessity criteria to determine the correct level of care for acute patients.
Assist physicians with transfer and discharge orders and communicate with them regularly about costs, cases, and desired patient outcomes.
Maintain knowledge of federal, state, and private agency review requirements and regulations, and educate healthcare team members about regulatory standards.
Promote effective and efficient use of clinical resources from admission through discharge.
Prepare and present denial letters as appropriate, complete PASRRs for skilled nursing facility admissions, and deliver Condition Code 44 letters while educating patients about Medicare benefits.
Research patient resources, including medication financial assistance, Medicaid-pending support, and equipment through outside facilities for patients with limited funding.
Introduce the Clinical Resource Manager role and explain how patients and families can make contact; serve as a patient advocate and support informed decision-making.
Participate in multidisciplinary rounds and conferences to review treatment goals, optimize resource use, provide family education, and identify post-hospital needs.
Use physician advisor referrals as appropriate and follow the department’s process for reviewing 30-day readmissions and its patient choice policy.
Document primary and backup plans, communications with patients, families, and the care team, and interventions in Power Chart.
Participate in department staff meetings and subteams.
Ensure discharge planning complies with Medicare Conditions of Participation and Joint Commission standards.
Accurately document services and supplies provided to patients.
Demonstrate the organization’s mission, vision, and values and the knowledge and skills needed to care for assigned age groups.