Bon Secours Mercy Health

Therapist

• The Advanced Psychoeducation Specialist provides direct patient care under the guidance of a designated healthcare professional in accordance with federal, state, and local regulations, and within policies, procedures, and guidelines of Bon Secours Mercy Health (BSMH).
• Facilitate Psychoeducation groups and provides individual activities tailored to specific needs of patients.
• May participate in family meetings and treatment team meetings.
• Offer community resource knowledge and coordination of activities.
• Complete assessments, care planning and discharge planning in collaboration with the Social Worker team.
• Provide one-on-one (1:1) patient safety companion service and patient checks as needed.
• Participate in continued education and in-service training.

Therapist – Behavioral Health

Manager

• Deploys system and market experience of care strategies, tactics, and behaviors.
• Institutes structure and processes that drive standardization of practices and policies across assigned market to continually drive quality and efficiency.
• Supports facility leadership by serving as a subject matter expert through data insight and training for understanding of their reports, provides support/guidance and patient experience reporting in appropriate venues/meetings.
• Participates in system and market experience of care committees and workgroups to consult and collaborate on system experience of care strategies and initiatives.
• Serves as a primary resource providing guidance, coaching, direction, and training to BSMH associates.
• Supports market leadership by providing reports, deep dive data drills, and organizes data analytics resources in partnership with regional director for meetings and other requests.
• Review EOC KPI targets and data regularly, identifies areas of strength and those with opportunities, drives performance based with collaborating leaders based on results while providing consistent feedback.
• Works in conjunction with Experience of Care and Market Leadership to develop market vision and strategic planning and implementation of strategies for patient experience.
• Serves, manages, and supports internal and external stakeholders and customers across the continuum of care.
• Participates as a team member and is accountable for own work responsibilities within assigned market or initiative.

Manager, Experience of Care

• The Practice Manager anticipates, plans, organizes and directs the operations of one or more physician practices
• Manage day-to-day operations of the practice, including staff and provider schedules, performance management, and ensure timely communication with team members
• Facilitates troubleshooting and follow up to ensure effective provider, staff, customer and peer relationships
• Adheres to established controls of quality, compliance and risk standards for day-to-day operations
• Functions as a key liaison for all new provider integration activities for the practice(s)
• Manages all revenue cycle processes, including but not limited to registration workflows, work queues, copays, daily cash drawer, bank deposits, and coding compliance
• Participates in planning and budgeting preparation and analysis
• Handles personnel functions, in collaboration with HR as appropriate, which includes check ins, evaluations etc.

Practice Manager – Cardiology

• Completes initial assessments, ongoing assessments and provides skilled therapeutic interventions to patients through the use of their educational knowledge, skill, and ability.
• Evaluates patients, gathering pertinent information from various sources, and develops an appropriate treatment plan with specific goals.
• Responsible for ongoing assessment, efficiency of treatment plan and revisions of plan as needed.
• Provides direct therapy to patients daily following patient’s plan of care and current standards of practice for Physical Therapy.
• Provides instruction in therapeutic procedures to patients and family.
• Maintains accurate and concise records on treatment provided and patient's progress.
• Documents all care provided, coordination of services, orders, goals, etc. in the patient’s electronic medical record in an accurate and timely manner.
• Provides timely co-signature for supervised physical therapy assistants, if applicable.
• Maintains set level of productivity without jeopardizing quality.
• Delivers efficient and effective care to patients meeting and exceeding department standards.
• Maintains departmental policies and procedures regarding safety, infection control, time off requests and timecard recording.
• Supervises the physical therapist assistant’s treatment interventions and professional growth.
• May precept in the direction and evaluation of clinical experience / internship of students from participating colleges or universities.
• Promotes rehabilitation services and wellness center activities with patients, family and caregivers, if applicable.
• Coordinates with other disciplines, agencies/companies, families, etc. to ensure that the care needs of the patient are met.

Ortho Physical Therapist

• Evaluates patients, gathering pertinent information from various sources, and develops an appropriate treatment plan with specific goals.
• Responsible for ongoing assessment, efficiency of treatment plan and revisions of plan as needed.
• Provides direct therapy to patients daily following patient’s plan of care and current standards of practice for Physical Therapy.
• Provides instruction in therapeutic procedures to patients and family.
• Maintains accurate and concise records on treatment provided and patient's progress.
• Documents all care provided, coordination of services, orders, goals, etc. in the patient’s electronic medical record in an accurate and timely manner.
• Provides timely co-signature for supervised physical therapy assistants, if applicable.
• Maintains set level of productivity without jeopardizing quality.
• Delivers efficient and effective care to patients meeting and exceeding department standards.
• Maintains departmental policies and procedures regarding safety, infection control, time off requests and timecard recording.

Physical Therapist – Outpatient – Pelvic Floor Rehabilitation and Therapy

Auditor

• Works collaboratively with the Compliance Manager on creating auditing protocols
• Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies
• Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas
• Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports
• Utilizes data analytics techniques, statistical analysis and modeling to detect and trend potential claims and billing compliance issues
• Assists in auditing and investigations requested by the System Director, Compliance
• Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes
• Develops educational content on documentation, coding, and trending of non-compliant activities

Healthcare Compliance Auditor – Enterprise Risk

• The Occupational Therapist plays a crucial role in enhancing patients' ability to perform daily tasks related to work and life.
• They conduct assessments, devise treatment plans based on physician referrals, and document patient progress.
• This encompasses outpatient, inpatient, pediatric, and off-site settings.
• Review physician referrals and patient medical history to determine therapy needs.
• Conduct and document patient evaluations, re-evaluations, and treatment plans according to department protocols.
• Administer prescribed occupational therapy treatments and create custom equipment for individual needs.
• Develop programs focusing on functional skills, vocational training, daily activities, and motor skills.
• Monitor progress and adjust treatment goals and plans as necessary, participating in patient care conferences.
• Educate patients and families on at-home treatment procedures.

Occupational Therapist – PRN

Security Engineer

• Provides internal and external safety/police functions to support the general safety of BSMH facilities
• Protects patients, visitors and employees by providing escorts, patrolling grounds, and mitigating environment of care safety hazards
• Deters criminal activity through routine patrols of all hospital property
• Enforces policies e.g. parking regulations, visitation policies, drug enforcement, and tobacco free/smoking policy
• Monitors hospital activity on closed circuit television to be alerted to any escalating situations
• Intervenes in patient, visitor and/or staff confrontations as appropriate
• Documents all duties performed including completion of daily activity logs and incident reports
• Demonstrates understanding of emergency procedures, alarm response, evacuation and internal and external disaster plans

Police Officer

Risk

• Effectively and efficiently manages liability claims, including hospital and employed physician claims
• Represents BSMH at pre-trial hearings, mediations, arbitrations and trials
• Manages and directs defense counsel in accordance with organizational objectives and goals
• Independently evaluates and resolves matters up to the position’s captive program settlement authority limit of $50,000.00
• Handles matters up to $500,000.00 in total exposure
• Utilizes risk investigations and expert reviews to evaluate legal liability and causation to set financial reserves
• Assigns appropriate defense counsel depending on venue, claim type, and potential claim value
• Works extensively with outside defense counsel to manage and resolve claims
• Conducts appropriate insurance coverage analysis for various lines of coverage on each liability claim
• Works closely with Loss Prevention to identify potential claims that would qualify for the Early Liability Review Program
• Maintains a diary system to track claim progression from report through investigation, evaluation, discovery, and analysis
• Responsible for obtaining defense counsel reports in a timely manner and directing litigation efforts according to department guidelines

Senior Claims Manager – Risk and Insurance

• Provides in-person guidance and support to the providers, care teams, and affiliates in clinical integration initiatives that supports the quadruple aim and allows the organization to thrive in a value-based health care model.
• Proactively maintaining a deep understanding of the key drivers for each practice, translating the data to insights for the practices, collaboratively identifying actionable steps for improvement through a Plan-Do-Study-Act (PDSA) process improvement model.
• Coaching care teams in process improvements, clinical integration, and outcomes.
• Completes in-person and virtual rounds in the practices on a regular basis to communicate status reports, key drivers of change, leading or lagging indicators, and providing insights to providers and practices.
• Manages the review of clinical outcomes, patient panel management, and performance metrics for affiliates and employed physicians in the assigned market or Region’s network.
• Partners with providers and care team members to implement evidence-based protocols and other improvement initiatives based on the insights, monitors ongoing progress, document supports, identify resources, and engages care delivery team.
• Conducts provider orientation and facilitates onboarding and offboarding of providers into the assigned network as related to panel management and other Clinical Integration key initiatives.

Clinical Outcomes Manager – Population Health

Financial Planning and Analysis

• Collecting, interpreting, and identifying trends in data
• Development of standard and ad hoc data reports for quality reporting and performance improvement
• Financial reclassifications and adjustments to the financial baseline as a result of approved contract changes
• Track KPIs and prepare financial reports
• Assist with budgeting and monthly close processes
• Develop financial projections and build financial models
• Ensure compliance with financial guidelines and company policies

Senior Financial Analyst

Customer Support

• Provides community based support and assistance to patients and staff to implement care plan as deemed necessary by the Care Coordination Team
• Assist clinical and administrative staff in for preparing patient appointments (pre-visit planning)
• Act as a resource to patients and families, providing answers to frequently asked questions and suggesting educational materials using Care Coordination Team Protocols
• Maintain comprehensive progress notes for each patient interaction
• Maintains good working relationships and knowledge of applicable community services
• Utilize interpersonal skills and community resources to effectively advocate for individuals in the communities served
• Maintains required data and documentation and prepares required reports for the Care Coordination Team
• Perform duties with minimal supervision. May be required to occasionally work irregular hours, attend other job related meetings, and perform other duties as assigned

Care Coordination Support Specialist – Population Health

Program Manager

• Provides leadership, oversight, coordination, and subject matter expertise for insights related to Population Health Clinical Integration RSA initiatives
• Collaborates with key stakeholders across the Ministry, including BSMH Population Health, Compliance and Revenue Cycle teams, Ensemble, and BSMH physicians and advance care clinicians
• Oversees prospective, concurrent, and retrospective chart reviews for diagnosis coding accuracy
• Supports payer relationships by coordinating chronic condition recapture and suspect condition validation processes
• Collaborates with plan representatives to obtain and analyze RSA gap data
• Facilitates responses to payer-focused HCC validation requests and communicates missed HCC trends to System Director of RSA for dissemination to clinical leadership
• Monitors payer suspect algorithms for potential internal HCC build improvements
• Partners with BSMH Compliance to deliver accurate HCC coding instruction as part of ambulatory provider training and onboarding
• Conducts medical record reviews and analyzes internal data to identify opportunities for real-time training intervention
• Coordinates and participates in collaborative coding forums to share best practices

Risk Score Accuracy Program Manager – Population Health

• Provide clinical care management services to identified eligible patients; coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care.
• Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources.
• Collaborate with patient, provider and care team to develop and implement a plan of care to ensure medically appropriate cost-effective care.
• Utilize Motivational Interviewing techniques as a patient-centered approach to activate patients in self-management of their chronic conditions with the goal of improved symptom management and interruption of a negative disease trajectory.
• Maintain a caseload of patients according to department policies.
• Identify, enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management.
• Develop and implement care plans to maximize healthcare outcomes and facilitate wellness with periodic review and update according to department protocols.
• Perform medication review and teach-back to ensure patient understanding and ability to adhere to medical regimen.
• Collaborate with PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.
• Perform patient outreach according to established protocols and document in electronic medical record.
• Identify, execute, and track needed referrals to care and community resources.
• Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, right time.
• Assist patient in advanced care planning to complete Advanced Directives.
• Document all communications with patient and/or care team in electronic medical record.

Registered Nurse, Ambulatory Care Manager – Population Health

• Provide clinical care management services to identified eligible patients; coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care
• Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources
• Collaborate with patient, provider and care team to develop and implement a plan of care to ensure medically appropriate cost-effective care
• Utilize Motivational Interviewing techniques as a patient-centered approach to activate patients in self-management of their chronic conditions
• Maintain a caseload of patients according to department policies
• Identify, enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management
• Develop and implement care plans with periodic review and update according to department protocols
• Perform medication review and teach-back to ensure patient understanding and adherence to medical regimen
• Collaborate with PCPs, Specialists, and Hospitalists to implement a patient-centered care plan
• Perform patient outreach according to established protocols and document in electronic medical record
• Identify, execute, and track needed referrals to care and community resources
• Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization
• Assist patient in advanced care planning to complete Advanced Directives
• Document all communications with patient and/or care team in electronic medical record

Registered Nurse – Ambulatory Care Manager, Population Health

Account Manager

• Primary Function/General Purpose of Position In collaboration with Market President, the Physician and Provider Relationship Manager is responsible for incremental improvement of in-network utilization through growth in new patient referrals across the BSMH Product Portfolio.
• Serves as strategic counsel to Market President, System Strategy and Marketing, Medical Group, and Population Health related to incremental growth opportunities and barriers.
• Acts as strategic growth expert to service line leaders as well as BSMH specialists building a new practice, collaborating to create a high impact growth plan with measurable targets.
• Using national, state, and local trends, benchmarks BSMH performance in KPIs most relevant to growth in product portfolio, identifying gaps and recommending matters most initiatives to market leadership.
• Conducts face to face visits with physicians, providers, and influencers to inform them of new services and/or changes in care delivery to optimize care coordination of in-network offerings for empaneled patients.
• Identifies barriers and facilitates resolution improving care delivery, often resulting in substantial process change and/or new service offerings.
• Identifies physicians and providers at risk of leaving network and partners with market leadership to create and operationalize a retention plan.
• Convenes market stakeholders to discuss and address competitive threats, performance improvement opportunities, and product differentiators to enable incremental growth.
• Aggregates and interprets multiple sources of data to inform creation and execution of strategic call plan, demonstrating measurable growth impact to product portfolio.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.

Physician and Provider Relationship Manager – Strategy

• SUMMARY Supports clinical and nonclinical risk management and the coordination of the centralized insurance program. Lines of business include professional liability, general liability, executive risk, property, cyber liability, crime, reinsurance for the captive, auto, aviation and others. The Risk & Insurance Manager independently manages the program/facility loss prevention strategies and initiatives, established in conjunction with the System Risk Director, and serves as a subject matter resource for assigned facilities and functional areas as directed. The Risk & Insurance Manager analyzes risk issues and directs and organizes loss prevention strategies and initiatives for assigned program or facility including proactive risk activities such as risk assessments, educational programs, consultations and ensuring compliance with the multiple laws and regulations affecting patients, visitors, employees and the community we serve. The Risk & Insurance Manager is responsible for keeping all Administrative and Clinical Leaders as well as Market/System Risk apprised of significant events and Risk Management activities within the scope of assignment. ESSENTIAL JOB FUNCTIONS Supports the strategic plan to address risk assumption/risk transfer and loss prevention activities associated with both physician and non-clinical risks. Participates in collection of underwriting information including collecting data needed for the captive, reinsurance, physician, and multiple commercial insurance policy renewals and bonds throughout the year and also maintains this data for historical purposes. Assists with evaluation of risk and the physician onboarding process into the captive. Maintains databases of insured entities, properties, vehicles, drivers, physicians, etc. in the risk management information system. Maintains schedules of insurance, policies, premiums, policy summaries, etc. Assists with physician credentialing and loss history requests. Participates in the risk analysis to determine effective loss prevention activities then implements loss prevention activities, including education, related to both clinical and non-clinical policies as directed by the System Director. Assists with ensuring compliance with patient compensation funds and other special state funds. Processes and tracks invoices, premium payments, premium returns, etc. Works with facilities, practice managers, real estate, finance, human resources and other internal departments to manage all certificate requests. Works on special projects and assists as needed. Must possess effective communication skills, ability to work well with others, professionalism, and a positive attitude. EMPLOYMENT QUALIFICATIONS Required Minimum Education: Bachelors Field of Study- Risk Management, Healthcare, Business, or related field Licensure/Certification Required : CPHRM (within 4 years of hire) Licensure/Certification Preferred : CPCU, ARM or similar certifications Minimum Years and Type of Experience Required : 3+ years in healthcare provision or administration, insurance, loss prevention or related field. Or combination of post-secondary education and experience in lieu of a degree. Minimum Years and Type of Experience Preferred: 5+ years in healthcare provision or administration, insurance, loss prevention or related field. FUNCTIONAL SKILLS REQUIRED Analyzing data or information Proficient in Microsoft Office Planning skills Organizational skills Data entry Electronic file management Analysis of risk Submit payments and credits for processing Assist with loss prevention Collection of data INTERPERSONAL SKILLS REQUIRED Attention to detail Critical thinking Team player attitude Responsible Dependable Motivation and work ethic Flexibility and adaptability Openness to feedback and ability to accept and support leadership decisions even if not in total agreement Positive attitude Excellent interpersonal skills with the ability to communicate effectively and actively listed in concerns identified

Risk Manager

• Provide clinical care management services to identified eligible patients; coordinating care to obtain desired health outcomes, improve self-care abilities, and decrease unnecessary cost of care.
• Perform standardized comprehensive needs assessment, identifying and addressing barriers to care and aligning patients with available benefits and resources.
• Collaborate with patient, provider and care team to develop and implement a plan of care to ensure medically appropriate cost-effective care.
• Utilize Motivational Interviewing techniques to activate patients in self-management of their chronic conditions.
• Maintain a caseload of patients according to department policies; identify, enroll and manage patients in program for Transitions of Care/Complex Case Management/Chronic Disease Management.
• Develop and implement care plans to maximize healthcare outcomes and facilitate wellness with periodic review and update according to department protocols.
• Perform medication review and teach-back to ensure patient understanding and ability to adhere to medical regimen.
• Collaborate with PCPs, Specialists, and Hospitalists to effectively implement a patient-centered care plan.
• Perform patient outreach according to established protocols and document in electronic medical record.
• Identify, execute, and track needed referrals to care and community resources.
• Provide resource management to improve care, patient experience and reduce unnecessary cost and utilization: right care, right place, right time.
• Assist patient in advanced care planning to complete Advanced Directives.
• Document all communications with patient and/or care team in electronic medical record.

Registered Nurse (RN), Ambulatory Care Manager, Population Health

• Assists in the review of Bon Secours Mercy Health coding, billing and claims processing policies and procedures for the development of compliance internal monitors and audit protocols and the prevention of fraud, waste and abuse.
• Develops compliance monitors and audit protocols specific to hospital revenue cycle risk areas highlighted by the OIG, Medicare, State Medicaid, State Insurance Fraud; Managed Care or Governmental Value-Based payment programs and/or other enforcement agencies on behalf of Bon Secours Mercy Health.
• Coordinates periodic review and analysis of Bon Secours Mercy Health hospital claims denial reports, operational assessment reports, internal quality control reviews, internal and external third party claims payment peer analysis systems to detect provider-billing trends, potential fraudulent or abusive billing practices or vulnerabilities indicative of potential underlying operational compliance issues.
• Utilizes data analytics techniques, statistical analysis and modeling, and databases developed internally, or in conjunction with other third party vendors to detect and trend potential claims and billing compliance issues relative to revenue cycle risk areas
• Assists in auditing and investigations requested by the System Director, Compliance.
• Assists in the development of compliance corrective action plans (CAP), oversight tools and technical edit enhancements to support revenue cycle services compliance and privacy efforts.
• Assists in and tracking of all activities related to recovery and repayment of inappropriate payments discovered as a result of claims audit or investigation.
• Maintains awareness of fraud, waste and abuse laws and regulations and current industry changes that may impact healthcare revenue cycle services domestic and international through personal initiative, continuing education and peer-to-peer networking.
• Ensures that the System Director, Compliance is apprised of local, remote and client-network emerging issues, adverse outcomes and/or deficiencies that could impact Bon Secours Mercy Health's public status.
• Develops educational content on documentation, coding, and trending of non-compliant activities to enhance compliance proficiency and competency, understanding of standards and the consequences of non-compliance.
• Prepares multi-faceted oral, written and electronic communications and presentations to facilitate discussion, networking, decision-making and proactive responses to meet current and emerging challenges among affected parties and entities.

Compliance Auditor - Enterprise Risk

Technical Program Manager

• Leads internal audit projects according to the audit plan throughout the Ministry, including risk assessment, audit performance, follow-up and ongoing communication of risks, results and mitigation efforts.
• Develops appropriate documentation to support audit work performed.
• Responsible for ongoing communication and collaboration with key partners including (but not limited to) Compliance, Legal, Finance, IT and Revenue Cycle.
• This position is fully remote, however must adhere to these two qualifications: 1) Be located within the United States 2) Willing to work Eastern Time hours in accordance with our business.
• Assists in risk assessment process and preparation of audit plan that focuses on high-risk areas.
• Conducts independent audits according to the audit plan and develops appropriate documentation to support audit work performed.
• Measures and tracks the results of audits performed through action plan follow-up procedures.
• Prepares reports to management of findings and proposed action plans for each audit.
• Assists in the preparation of audit reports for presentations to management and governance; may present findings to management as appropriate.
• Communicates and prepares meeting agendas and status reports to facilitate discussion with immediate supervisor and upper management about audit activities in progress and emerging issues in a timely and proactive manner.
• Keeps current on industry trends and areas of interest through utilization of industry research and knowledge resources.
• Displays a commitment to excellence, accuracy and thoroughness in all activities, and searches for ways to improve and promote quality.
• Participates in department process improvement efforts.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.