GENERAL DESCRIPTION
Clinical Resource Specialist responsibilities include providing case management/utilization review and planning to determine care needs while providing decision support to physicians. Clinical Resource Specialists maintain responsibility for all administrative aspects of clinical work. Clinical resource Specialists aim to synthesize all available evidence for major clinical topics for healthcare workers when providing patient care. They apply medical knowledge and best evidence within the context of providing patient care. Daily responsibilities may include onboarding new clinical and non-clinical employees, training existing employees who work directly with patients, reviewing treatment plans, or communication with other internal and external departments.
QUALIFICATION REQUIREMENTS
- Must hold an unexpired Registered Nurse license, in good standing.
- Prefer two to five years of experience with a record of achievement.
- Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
- Basic level skill in Microsoft Office (including Word, Excel, PowerPoint, etc.).
QUALIFICATIONS PREFERRED
- Bachelors’ degree in nursing or equivalent required (nursing degree preferred).
- State Board of Nursing License required.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Knows, understands, and demonstrates the organization’s mission, vision and values.
- Demonstrates knowledge and skills to competently care for all assigned patients
- Completes screening assessments of physician assigned cases to determine medical necessity/status determination needs. Reassesses, monitors, and modifies transition needs as appropriate.
- Conducts concurrent medical record review using established medical necessity criteria to determine correct level of care for patients.
- Provides education to all health care team members regarding requirements to meet regulatory standards.
- Promotes effective and efficient utilization of clinical resources from start of care to finish.
- Serves as a patient advocate.
- Assists in creation of Letters of Medical Necessity and Appeal Letters for MD
NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES
- Ability to prioritize and handle multiple tasks and projects concurrently.
- Must have scheduling flexibility and be able to work overtime.
- Develop and maintain relationships with physicians, hospital, patients, and other ancillary medical professionals.
- Careful attention to detail.
- Performs related duties as requested.
- Participates in quality assurance activities and audits as directed.
KNOWLEDGE, SKILLS AND ABILITIES REQUIREMENTS
- Ability to actively communicate, inspire and motivate all levels of staff.
- Ability to think and act strategically and proactively.
- Ability to maintain accurate records and prepare reports and correspondence related to the work.
- Ability to maintain favorable public relations.
- Ability to organize and coordinate the work of others.
- Ability to set priorities.
- Excellent verbal, written, and communication skills.
- Excellent group presentation skills.
- Excellent analytical skill.
Communication Skills
- Oral Communication – Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
- Written Communication – Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Computer Skills
- Become and remain proficient is all programs necessary for execution.
PHYSICAL DEMANDS AND WORK ENVIRONMENT
- This position requires constant sitting with occasional walking, standing, kneeling or stooping.
- This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.
- This position requires constant talking and hearing.
- Specific vision abilities required by this job include close vision and the ability to adjust focus.
- This position must occasionally lift and/or move up to 20 pounds
- Required to move/lift physical hardware.
AMERICANS WITH DISABILITY SPECIFICATIONS
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.
OTHER
- Some examples are provided below:
- Will participate in legal and ethical compliance training each year.
- Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures.
- Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual.
- Will not participate in any conduct considered to be unethical or illegal.
EXPECTATION FOR ALL EMPLOYEES
Supports the organization’s mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm.
GENERAL INFORMATION:
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.
The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.
Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization’s services (may include: visitors, patients, employees, or others).