TechWolf/Skill-XL huggingface dataset:
To achieve our vision and mission, ALL organization
team members are expected to demonstrate and live the following:
Serve:
ALWAYS...
Welcome everyone by making eye contact, greeting with a smile, and saying "hello"
Acknowledge when patients/guests are lost and escort them to their destination or find someone who can assist
Refrain from using cell phones for personal reasons in public spaces or patient care areas
Excel:
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: assume responsibility
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: accept own accountability
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: show professional responsibility
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: assess quality of services
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: provide high quality customer service
Recognize and take personal responsibility to address and recover from service breakdowns when a customer's expectations have not been met
Skill: guarantee customer satisfaction
Offer patients and guests priority when waiting (lines, elevators)
Skill: provide high quality customer service
Offer patients and guests priority when waiting (lines, elevators)
Skill: maintain customer service
Offer patients and guests priority when waiting (lines, elevators)
Skill: deliver outstanding service
Offer patients and guests priority when waiting (lines, elevators)
Skill: satisfy customers
Work on improving quality, safety, and service
Skill: manage quality
Work on improving quality, safety, and service
Skill: oversee quality control
Work on improving quality, safety, and service
Skill: quality standards
Work on improving quality, safety, and service
Skill: advise on safety improvements
Work on improving quality, safety, and service
Skill: advise on safety measures
Work on improving quality, safety, and service
Skill: have a high level of safety awareness
Work on improving quality, safety, and service
Skill: apply safety management
Work on improving quality, safety, and service
Skill: instruct on safety measures
Work on improving quality, safety, and service
Skill: deliver outstanding service
Work on improving quality, safety, and service
Skill: provide high quality customer service
Work on improving quality, safety, and service
Skill: maintain customer service
Work on improving quality, safety, and service
Skill: assess quality of services
Respect:
Respect cultural and spiritual differences and honor individual preferences.
Skill: respect the diversity of cultural values and norms
Respect cultural and spiritual differences and honor individual preferences.
Skill: respect cultural preferences
Respect cultural and spiritual differences and honor individual preferences.
Skill: show intercultural awareness
Respect everyone's opinion and contribution, regardless of title/role.
Skill: show professional responsibility
Respect everyone's opinion and contribution, regardless of title/role.
Skill: keep an open mind
Speak positively about my team members and other departments in front of patients and guests.
Skill: reinforce positive behaviour
Value the time of others by striving to be on time, prepared and actively participating.
Skill: manage time
Pick up trash, ensuring the physical environment is clean and safe.
Skill: maintain work area cleanliness
Pick up trash, ensuring the physical environment is clean and safe.
Skill: workplace sanitation
Pick up trash, ensuring the physical environment is clean and safe.
Skill: maintain a safe, hygienic and secure working environment
Pick up trash, ensuring the physical environment is clean and safe.
Skill: health and safety in the workplace
Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Skill: manage resources
Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Skill: manage physical resources
Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Skill: perform resource planning
Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Skill: manage supplies
Be a good steward of our resources, using supplies and equipment efficiently and effectively, and will look for ways to avoid waste.
Skill: mitigate waste of resources
Engage:
Acknowledge wins and frequently thank team members and others for contributions.
Show courtesy and compassion with customers, team members and the community.
Skill: show empathy
Show courtesy and compassion with customers, team members and the community.
Skill: relate empathetically
Inpatient Care Transitions (ICT) Nurse
Care Management
Skill: implement nursing care
Care Management
Skill: plan nursing care
Care Management
Skill: implement fundamentals of nursing
Care Management
Skill: provide professional care in nursing
Care Management
Skill: apply a holistic approach in care
Care Management
Skill: coordinate care
Inpatient UM Supervisor
Classification:
Non-Exempt
Temporary Full-Time Regular
POSITION SUMMARY
Proactively conduct on-site concurrent and retro reviews of inpatient utilization according to organization's clinical criteria guidelines.
Skill: perform on-treatment review
Proactively conduct on-site concurrent and retro reviews of inpatient utilization according to organization's clinical criteria guidelines.
Skill: manage operations in healthcare institutions
Proactively conduct on-site concurrent and retro reviews of inpatient utilization according to organization's clinical criteria guidelines.
Skill: follow clinical guidelines
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: develop plans related to the transfer of care
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: manage operations in healthcare institutions
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: apply caseload management
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: ensure compliance with policies
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: ensure compliance with company regulations
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: company policies
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: apply company policies
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: organisational policies
Implement and assist in the utilization management processes, according to departmental policies and procedures.
Skill: follow company standards
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: apply case management
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: acute care
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: specialist nursing care
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: develop plans related to the transfer of care
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: apply a holistic approach in care
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: coordinate care
Case Manage patients with complex post-acute care needs according to the Care Transitions model.
Skill: plan nursing care
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: develop plans related to client discharge
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: carry out nurse-led discharge
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: multi-professional cooperation in health care
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: cooperate at inter-professional level
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: work in multidisciplinary health teams
Coordinate with clinics and outside agencies to facilitate discharge planning of patients.
Skill: cooperate with professionals
Responsible for denial letters required by HMO contracts and other parties.
ESSENTIAL POSITION RESULTS
The essential functions listed are typical examples of work performed by positions in this job classification.
They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks and responsibilities.
Employees may perform other duties as assigned.
Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
Skill: review patient's medical data
Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
Skill: develop plans related to client discharge
Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
Skill: develop plans related to the transfer of care
Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
Skill: carry out nurse-led discharge
Manage and coordinate in-patient review and discharge planning and case management activities related to immediate post-discharge needs.
Skill: apply case management
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: coach individuals in specialised nursing care
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: develop training programmes
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: develop plans related to the transfer of care
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: involve service users and carers in care planning
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: develop plans related to client discharge
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: carry out nurse-led discharge
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: provide information
Train in and implement Care Transitions model in discharge planning; participate in diffusion of model in clinic setting.
Skill: promote the transfer of knowledge
Support proactive hospital discharge planning, transfers, and redirection.
Skill: develop plans related to client discharge
Support proactive hospital discharge planning, transfers, and redirection.
Skill: carry out nurse-led discharge
Support proactive hospital discharge planning, transfers, and redirection.
Skill: transfer patients
Support proactive hospital discharge planning, transfers, and redirection.
Skill: develop plans related to the transfer of care
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: think proactively
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: work in teams
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: establish collaborative relations
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: cooperate with colleagues
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: maintain relationships with doctors
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: multi-professional cooperation in health care
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: educate patient's relations on care
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: carry out nurse-led discharge
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: develop plans related to client discharge
Proactively and collaboratively, interface with medical director, HMO's, clinic and facility staff, outside agencies, member and their families to assist in expediting appropriate discharge and coordination of care.
Skill: coordinate care
Meet departmental review and documentation standards for work assignments.
Skill: adhere to standard procedures
Meet departmental review and documentation standards for work assignments.
Skill: adhere to organisational guidelines
Meet departmental review and documentation standards for work assignments.
Skill: develop documentation in accordance with legal requirements
Meet departmental review and documentation standards for work assignments.
Skill: professional documentation in health care
Write denial letters, and other Notices of Action, to member/providers using HMO templates.
Skill: respond to inquiries in written form
Write denial letters, and other Notices of Action, to member/providers using HMO templates.
Skill: prepare health documentation
Write denial letters, and other Notices of Action, to member/providers using HMO templates.
Skill: manage information in health care
Serve as a liaison between hospital, clinics, health plan, vendors, outside agencies, and providers.
Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
Skill: negotiate service with providers
Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
Skill: respond to customers' inquiries
Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
Skill: assist customers
Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
Skill: respond to enquiries
Work with health plans on special requests such as obtaining ancillary services from non-contracting providers.
Skill: answer patients' questions
Assist UM Director in the periodic review and update of UM/Case Management policy and procedures, and in the ongoing evaluation and improvement of workflow systems for UM.
Skill: business processes
Assist UM Director in the periodic review and update of UM/Case Management policy and procedures, and in the ongoing evaluation and improvement of workflow systems for UM.
Skill: identify process improvements
Assist UM Director in the periodic review and update of UM/Case Management policy and procedures, and in the ongoing evaluation and improvement of workflow systems for UM.
Skill: improve business processes
Coordinate completion and send required UM monthly reports to Health Plans, as assigned
Skill: write routine reports
Coordinate completion and send required UM monthly reports to Health Plans, as assigned
Skill: write work-related reports
HIPAA Designated Access
"For the purposes of the job duties of this position, the person in this position requires access only to the following HIPAA protected information data sets"
MSO Membership
MSO Claims
MSO Referral/Auth.
MSO Capitation
Data Warehouse
Skill: data warehouse
Data Warehouse
Skill: implement data warehousing techniques
Data Warehouse
Skill: manage data
Chart Audit/QI
Disease Registry
SUPERVISORY RESPONSIBILITIES
Competent leadership and administrative skills.
Skill: leadership principles
Competent leadership and administrative skills.
Skill: leadership in nursing
Competent leadership and administrative skills.
Skill: lead a team
Competent leadership and administrative skills.
Skill: office administration
Competent leadership and administrative skills.
Skill: manage administrative systems
Competent leadership and administrative skills.
Skill: administrative tasks in a medical environment
Competent leadership and administrative skills.
Skill: maintain professional administration
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: communication
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: use communication techniques
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: customer relationship management
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: maintain relationship with customers
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: communicate with customers
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: teamwork principles
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: work in teams
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: work independently
Good communication and customer relations' skills; ability to work well with a team and independently.
Skill: handle tasks independently
Utilization Management and Case Management experience; understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, Commercial).
Skill: manage operations in healthcare institutions
Utilization Management and Case Management experience; understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, Commercial).
Skill: apply case management
Utilization Management and Case Management experience; understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, Commercial).
Skill: health care legislation
Utilization Management and Case Management experience; understanding and knowledge of healthcare benefits associated with various business lines (Medi-Cal, Medicare, Commercial).
Skill: health care system
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: perform on-treatment review
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: monitor patients' progress related to treatment
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: assist patients with special needs
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: treat medical conditions of elderly people
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: assist in the administration of medication to elderly
Inpatient concurrent review, especially working with complex medical patients, including aged, blind, disabled.
Skill: disability care
Ability to work independently in most instances, requiring limited supervision.
Skill: work independently
Ability to work independently in most instances, requiring limited supervision.
Skill: handle tasks independently
Ability to work independently in most instances, requiring limited supervision.
Skill: exercise self-control
Proficiency in computer operations and comfortable with Internet-based applications.
Skill: have computer literacy
Fundamental word processing and computer navigation skills.
Skill: use word processing software
Fundamental word processing and computer navigation skills.
Skill: have computer literacy
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: make decisions
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: make independent operating decisions
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: solve problems
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: create solutions to problems
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: solve problems in healthcare
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: think critically
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: address problems critically
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: think analytically
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: make clinical decisions
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: clinical decision-making at advanced practice
Sound decision-making skills including problem solving, critical thinking, and good clinical judgment for clinical and non-clinical issues.
Skill: use clinical reasoning
Logical, independent thinker.
Skill: think analytically
Professional demeanor.
Skill: demonstrate professional attitude to clients
Essential Requirements
1 year Utilization Management in hospital, HMO, or IPA setting.
Skill: apply caseload management
1 year in health care delivery setting at hospital, clinic or physician's office.
Skill: provide healthcare services to patients in general medical practice