Pentec Health Hiring For Renal Clinical Case Manager at Glen Mills, PA  Full Time

Objective:

This role provides clinical expertise for IDPN and IPN therapies under the daily direction and guidance provided by the Clinical Manager of Operations:

O providing clinical expertise in the management of these therapies;

O managing internal aspects of therapy approval and authorization;

O assisting with all clinical aspects needed for reimbursement within revenue cycle management;

O assisting where needed for all clinical aspects of Pentec Health, Inc.

Travel Requirements

At the Discretion of the Supervisor

Essential Duties & Responsibilities:

* Assists in developing renal program to increase the client base for IDPN/IPN and other forms of Parenteral and Enteral Nutrition (PEN) and related services at the direction of Clinical Manager of Operations, Renal Program Clinical Director and other members of the Pentec Health Management team.

* Provides Clinical Assistance for all patients within the territory with routine evaluation and monitoring of patients requiring IDPN and IPN nutritional therapies.

* Is responsible for coordinating with the CSR and AE to assure monthly labs and payor required documents are obtained for all active patients on therapy and assists AE by reviewing the queue.

* Is available to organize or assist with CEU and Web-Ex CEU seminars; conduct live displays and educational sessions regarding the use of IDPN/IPN and other nutritional therapies.

* Performs such additional tasks as is necessary to insure the quality of care within the department of Nutritional Support Services.

* Expedite the conversion of Referrals to Starts.

* Assists to maintain quality patient therapy by providing clinical expertise and actively participating in the process for authorization and re-authorization of patients requiring IDPN and IPN therapies as needed.

• Consults with Clinical Manager of Operations to provide clinical and technical expertise to the Customer Service Representatives and Insurance Coordinators in case management and authorization related issues which includes but is not limited to:
  • Identifying potential candidates for IDPN or IPN by evaluating clinical parameters for indication of need of therapy relevant to diagnoses
  • Confirming patient qualification criteria for therapy are met prior to commencement of therapy, as per specific client/dialysis chain requests
  • Determining qualifiable diagnoses and evaluating clinical parameters for indication of continuation (re-authorization) of therapy

• Acts as clinical Subject Matter Resource for Renal Dietitians, Nurses, Nephrologists, Account Executives and/or other field staff as well as Revenue Cycle Management staff.

• Completes all necessary forms, documents and letters/statements of medical necessity as needed by renal centers, dialysis chains or payors. Escalates insurance denials as needed, in conjunction with Insurance Coordinators and/or Billers/Collectors, to payors to obtain approvals for coverage through telephone consultations or via written appeal letters

• Participates in the Quality Management overview reviewing current and proposed processes and improvements

Clinical Assistance Program

• Quarterly assessment (or earlier time frame if requested by AE/customer) for all

patients currently on service (IDPN and IPN) therapies to identify those patients not responding.

• Utilizing the “Guidelines for Formula Changes” documents, develops a plan of care for those patients who are not responding.

• Coordinates any needed prescription changes with the unit RD.

• Provides other aspects of Clinical Assistance desired by customer e.g. albumin

graphs of active patients; handling customer questions and addressing intolerance issues

• Documents appropriately in the patient record for those patients requiring formula changes or special formulation/changes as per the “Guidelines for Formula Changes”.

Authority and Accountability:

* Professional Level Individual Contributor

Skills, Competencies and Experience:

Required

* Experience in renal nutrition, especially in CKD 5 Dialysis, along with experience in dialysis related parenteral nutrition support therapies is required (IDPN required; IDPN/IPN preferred). Requires that this person is a Registered Dietitian for at least two years.

• Able to work autonomously and make independent decisions within generally accepted medical practices, regulations and guidelines.

• 1-2 years of practical experience in a full service Dialysis facility

Preferred

• Knowledge of health insurance and third party reimbursement helpful.

Education, Certifications, Trainings:

Required

1. B.S. degree in Nutrition or related equivalent

a. Registered Dietitian or Licensed Nutritionist as required by State

Preferred

* CNSC Preferred or other advanced degree or certification

Equipment:

Required

• Intermediate computer skills with programs such as Microsoft Office Suite: Outlook, Word, Excel and Power Point