Loan Manager Salary in Billings, MT

The Patient Financial Representative (PFR) is the main financial contact for patients with self pay balances and/or without adequate financial resources. The PFR looks after the financial interests of the organization by securing sponsorship for patients unable to pay and collecting from patients able to pay. The PFR interacts with patients prior to service through financial counseling at the time of pre-registration and pre- certification, at the time of service through bedside financial counseling, point of service collections, and after service collections through tracking of Medicaid, SSI, SSDI, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance applications, bank loan program, and telephone collections.Essential Job Functions• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance. • Performs financial counseling for self pay, MVA, and commercial insurance patients with deductibles greater than established guidelines, resolves any issue that the patient presents from areas in the hospital, clinics, nursing home, and other areas of Billings Clinic. Duties include interviews with patient and family members, identification of potential eligibility for SSI, SSDI, Medicaid, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance program and promotion of bank loan program. As each patient's needs differ, assesses the situation and initiates the appropriate method to recommend/resolve the patient's concern/dispute/issue. • Completes daily follow-up on outstanding self-pay balances. Daily performance includes but is not limited to speaking with patients in person, making and receiving telephone calls, establishes and monitors payment plans per policy and procedures and renegotiates payment plan arrangements when new accounts are combined into the payment plan or when patient's circumstances change. Negotiates within established guidelines discounts with customers, including patients, attorneys and collection agencies. Dispute resolutions coordinating/working with Risk Management, Department Managers, Coding and Compliance, Insurance, Physicians, and any other area necessary to resolve the patient issues. Obtains HIPAA authorization forms, reviews and resolves issues identified in daily correspondence/ interoffice mail and replies to patient either by return mail or by phone. Performs customer service by providing assistance to customer inquiries including account information, insurance billing issues, and quality of care issues as appropriate. Coordinates with other departments as appropriate and advises patients about the outcome. • Coordinates financial counseling efforts with entities of Billings Clinic, other physician's offices, other community health care providers and patients regarding insurance related information, procedures cost and charge estimates, coverage issues, and options for patients without insurance. Provides itemized statements needed by patients for their flex plans and other insurance coverage requiring a statement from the patient. • Accepts over the counter cash, check, credit /debit card payments, check by phone, completes employee payroll deduction forms, and finalizes bank loan paperwork with patients. Monitors, posts and adjusts on all collection agency payments. • Evaluates self-pay account balances for transfer to bad debt and assignment to outside collection agencies. Handles all functions required under bankruptcy discharges and requirements. • Utilizes performance improvement principles to assess and improve quality. • Provide Financial Counseling as a Certified Application Counselor for the Health Insurance Market Place • Identifies needs and sets goals for own growth and development; meets mandatory organizational and departmental requirements. • Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance. • Performs other duties as assigned or needed to meet the needs of the department/organization.

Under general supervision, operates radiographic equipment to obtain ordered radiographs consistent with department routines and procedures. In doing so, positions patients, adjusts equipment for proper exposure settings and develops films/images following the procedure and facilitates image storage in the PACS system. Also assists physicians and Radiology RPAs in performing examinations by administering/providing contrast media and assisting with procedures as needed.This position may be eligible for a sign-on incentive, relocation, and tuition loan reimbursement. Essential Job Functions •Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.•Ensures radiological services provided are in compliance with standards established by Billings Clinic, local, state and federal agencies.•Performs quality procedures and radiographs using the appropriate department routine as ordered and be able to perform those examinations using all the general radiographic equipment.•Prepares the room, equipment and supplies as dictated by the particular examination or patient need and processes the necessary radiographs.•Prepares the patient for the examination by ensuring the patient is attired properly, explains the examination to the patient and transfers and positions the patient as needed. Demonstrates awareness of radiation safety for patients, self and co-workers in particular by using appropriate shielding for patients. Assists the patient at the end of the examination.•Informs Manager or Supervisor of any unusual concerns, situations or conditions relative to staff, patients and physicians. Assists with stocking and cleaning their assigned room daily. Maintains adequate inventory of all required supplies by appropriately utilizing supply management software/hardware and/or informing appropriate personnel for acquisition.•Performs a variety of clerical and image management tasks, as required, such as working up patients, completing the appropriate paper work following each examination, properly identifies exams for PACS storage and review.•Identifies need and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.•Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.•Is responsible for taking an active role in the mentoring of the student technologist staff.•Performs other duties as assigned or need to meet the needs of the department/organization.

Under the general supervision of the Manager, the MRI Technologist operates and maintains the magnetic resonance scanner, enhances public awareness concerning magnetic resonance imaging, and assures the safety of patients and public in application of high quality diagnostic magnetic resonance (MR) images.This position may be eligible for sign on incentive, tuition loan repayment and relocation. Essential Job Functions•Supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service.•According to established procedures and protocols, prepares patient for exam by assisting with dressing and undressing; assuring the removal of all metal objects and proper patient screening, lifting and assisting the patient to the exam table, proper positioning and preparation for the MR exam.•Responsible for patient and family education prior to the procedure, minimizing claustrophobic reactions and obtaining cooperation from the patients.•Performs the MR procedures that best assists the referring physician and radiologist in obtaining a diagnosis and improving patient management. Uses personal judgement in protocol development. Involves the radiologist and referring physician in protocol selection.•Maintains patient and visitor safety with regard to entering the scan room. Ensures that no ferromagnetic objects enter the scan room. Ensures that personal articles are not inadvertently carried into the room and damaged. Responsible for maintaining the security zone strictly limiting access to the magnet room.•Provides the radiologist with digital images within 30 minutes of completed exam. Ensure proper patient history and scan protocol information is included. All pertinent information is supplied to the radiologists expediently. Assists radiologist with directly viewing and manipulating images via viewing console and network technologies.•Performs secretarial, clerical duties as required. May assist with proper patient scheduling, patient registration, answering questions and filing.•Takes an active role in policy formation and revision. Make recommendations to Manager for changes. Participation in the development of departmental goals and objectives. Will make recommendations and presentations to Medical Directors and other health care professionals when requested. This includes typing skills, computer skills, presentation skills and basic research abilities.•Responsible for proper venipuncture technique to inject contrast media under the supervision of a radiologist or assist the Radiology RN in establishing proper vein access. Must be prepared to aggressively assist or take responsibility in an emergency situation.•Maintains knowledge of current applications within field by reading appropriate journal articles, attending lectures, in-services and seminars. Must utilize these resources to self-teach basic MR physics during the first year in absence of accredited MR training program. Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.•Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.•Performs other duties as assigned or needed to meet the needs of the department/organization including maintaining inventory of medical supplies, linen, , other associated scan supplies; maintaining a neat, orderly work area; cleaning magnet and patient transport table; maintaining other ancillary equipment.

Under general supervision, operates radiographic equipment to obtain ordered radiographs consistent with department routines and procedures. In doing so, positions patients, adjusts equipment for proper exposure settings and develops films/images following the procedure and facilitates image storage in the PACS system. Also assists physicians and Radiology RPAs in performing examinations by administering/providing contrast media and assisting with procedures as needed.This position may be eligible for sign-on incentive, relocation, and tuition loan repayment. Essential Job Functions •Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.•Ensures radiological services provided are in compliance with standards established by Billings Clinic, local, state and federal agencies.•Performs quality procedures and radiographs using the appropriate department routine as ordered and be able to perform those examinations using all the general radiographic equipment.•Prepares the room, equipment and supplies as dictated by the particular examination or patient need and processes the necessary radiographs.•Prepares the patient for the examination by ensuring the patient is attired properly, explains the examination to the patient and transfers and positions the patient as needed. Demonstrates awareness of radiation safety for patients, self and co-workers in particular by using appropriate shielding for patients. Assists the patient at the end of the examination.•Informs Manager or Supervisor of any unusual concerns, situations or conditions relative to staff, patients and physicians. Assists with stocking and cleaning their assigned room daily. Maintains adequate inventory of all required supplies by appropriately utilizing supply management software/hardware and/or informing appropriate personnel for acquisition.•Performs a variety of clerical and image management tasks, as required, such as working up patients, completing the appropriate paper work following each examination, properly identifies exams for PACS storage and review.•Identifies need and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.•Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.•Is responsible for taking an active role in the mentoring of the student technologist staff.•Performs other duties as assigned or need to meet the needs of the department/organization.

The Patient Financial Representative (PFR) is the main financial contact for patients with self pay balances and/or without adequate financial resources. The PFR looks after the financial interests of the organization by securing sponsorship for patients unable to pay and collecting from patients able to pay. The PFR interacts with patients prior to service through financial counseling at the time of pre-registration and pre- certification, at the time of service through bedside financial counseling, point of service collections, and after service collections through tracking of Medicaid, SSI, SSDI, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance applications, bank loan program, and telephone collections.Essential Job Functions• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance. • Performs financial counseling for self pay, MVA, and commercial insurance patients with deductibles greater than established guidelines, resolves any issue that the patient presents from areas in the hospital, clinics, nursing home, and other areas of Billings Clinic. Duties include interviews with patient and family members, identification of potential eligibility for SSI, SSDI, Medicaid, MCP, VA, Crime Victims, CHIP, liens, estates, financial assistance program and promotion of bank loan program. As each patient's needs differ, assesses the situation and initiates the appropriate method to recommend/resolve the patient's concern/dispute/issue. • Completes daily follow-up on outstanding self-pay balances. Daily performance includes but is not limited to speaking with patients in person, making and receiving telephone calls, establishes and monitors payment plans per policy and procedures and renegotiates payment plan arrangements when new accounts are combined into the payment plan or when patient's circumstances change. Negotiates within established guidelines discounts with customers, including patients, attorneys and collection agencies. Dispute resolutions coordinating/working with Risk Management, Department Managers, Coding and Compliance, Insurance, Physicians, and any other area necessary to resolve the patient issues. Obtains HIPAA authorization forms, reviews and resolves issues identified in daily correspondence/ interoffice mail and replies to patient either by return mail or by phone. Performs customer service by providing assistance to customer inquiries including account information, insurance billing issues, and quality of care issues as appropriate. Coordinates with other departments as appropriate and advises patients about the outcome. • Coordinates financial counseling efforts with entities of Billings Clinic, other physician's offices, other community health care providers and patients regarding insurance related information, procedures cost and charge estimates, coverage issues, and options for patients without insurance. Provides itemized statements needed by patients for their flex plans and other insurance coverage requiring a statement from the patient. • Accepts over the counter cash, check, credit /debit card payments, check by phone, completes employee payroll deduction forms, and finalizes bank loan paperwork with patients. Monitors, posts and adjusts on all collection agency payments. • Evaluates self-pay account balances for transfer to bad debt and assignment to outside collection agencies. Handles all functions required under bankruptcy discharges and requirements. • Utilizes performance improvement principles to assess and improve quality. • Provide Financial Counseling as a Certified Application Counselor for the Health Insurance Market Place • Identifies needs and sets goals for own growth and development; meets mandatory organizational and departmental requirements. • Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance. • Performs other duties as assigned or needed to meet the needs of the department/organization.

May be eligible for $3,000 sign on incentiveMay be eligible for relocation assistanceMay be eligible for tuition loan reimbursementUnder the direction of department leadership, the Utilization Review/ Management RN. This position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, and coordination to decrease avoidable denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments.Essential Job Functions•Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. •Maintains competency in all organizational, departmental, and outside agency requirements.•The responsibilities of the UR case manager are listed below, in order of priority and intended to ensure effective prioritization of tasks.•Priority 1: Reviews New Admissions, Observation and Outpatient Cases•Prioritize reviews of all OBS and bedded Outpatients•Communicate with attending physician to discuss case and obtain information not documented in record, when OBS cases do not meet payer criteria or OBS ≥ 24 hours•Communicate with attending physician for OBS patients meeting medical necessity for inpatient level of care to obtain inpatient order•Communicate with Case Manager to understand discharge plan and barriers to discharge on OBS and Outpatient in a Bed patients•Participate in daily OBS call and communicate why patient is here, what we need from the team to get the patient to the next level of care, and expected discharge plan•Ensure that admission review is completed on assigned units/worklist using payer MCG or CMS 2 Midnight Rule within 24 hours of admission•Identify incomplete reviews from worklist•Validate OBS orders daily for new admissions, within 24 hours•Ensure order in chart coincides with the payer review, CMS 2 Midnight Rule, or payer authorization for status and level of care•Priority 2: Performs Utilization Review (UR) Activities•Completes concurrent Level of Care (LOC) & status reviews utilizing payer criteria to assure all days of hospitalization are covered/certified or meet CMS 2 Midnight Rule (as appropriate) at minimum of every 3 days or more frequently based on payer requirements•Reviews observation patients at a minimum twice a day. Communicates with attending on medical plan and Case Manager on discharge plan to expedite progression to next level of care or discharge•Discusses case with attending when payer authorization does not match status or level of care.•Obtains information not documented in the EMR and requests documentation of medical necessity to support appropriate status (IP, OP, OBS) and level of care (Med-surg, SDU, ICU, etc.)•If attending is unable to provide additional clinical information supporting status or LOC, escalate case to the physician advisor for second level review as early as possible and before leaving for the day•Communicates to Case Manager any discrepancies on status or level of care based on medical necessity and/or payer authorization discrepancies•Communicates to Case Manager on current outliers, potential outliers, and denials•Identifies reviews that need to be completed on assigned floors and follows all assigned patients through completion and submission of Discharge Summary•Assesses if all days are authorized/certified by respective payers and communicate any issues/denials to attending physician, CM, and department leadership•Conducts UR until all tasks are completed; indicates UM Complete in authorization and/or certification•Communicates with payer UR representatives on status/level of care authorizations that do not match MCG review•Denotes relevant clinical information to proactively communicate with payers for authorizations of treatments, procedures, and Length of Stay; sends clinical information as required by payer•Notifies appropriate parties of any changes in financial class including conversions, Hospital-Issued Notices of Noncoverage (HINN), Condition Code 44, and Important Message from Medicare (IMM).•Follows department procedures and policies for Condition Code44, Physician Advisor review, and HINN processes•Documents Avoidable Days/Delays, per department process/procedure/policy•Priority 3: Maintains an Active Role in Denial Prevention and Management•Uses payer MCG criteria and supporting documentation to justify the patient's medical necessity for observation, admission and/or continued stay•Proactively interacts with payers and proactively sends clinical reviews to prevent inpatient denials•Proactively communicates with payer UM representatives on denials and coordinate peer to peer review with payer's medical director•Initiates and coordinates peer to peer reviews on all concurrent denials•Understands payer requirements and government regulations to ensure compliant, safe, and cost-effective healthcare•Priority 4: Identify Prolonged LOS patients, readmission, or complex discharge needs patients•Identifies Prolonged LOS patients or complex patients/situations and communicate to the CM and/or Social Worker as appropriate•Priority 5: Escalation•Refers cases that require second level review to Physician Advisor, Manager, and Director per department process or procedure•Discusses status/level of care and payment barriers with attending for resolution, if unsuccessful, escalate to department leadership and Physician Advisor, per department process or procedure•Insurance and Utilization Management•Maintains working knowledge of CMS requirements and readmission penalties•Maintains working knowledge of insurance/payer benefits•Documentation•Documents accurately and in a timely manner in the Electronic Medical Record per program guidelines•Utilizes standards of professional practice in all documentation and communication consistent with organization/department policy as well as the Board of Nursing and ethical guidelines established and universally supported by the nursing profession•Assures documentation and patient information is secure and maintained in accordance with Billings Clinic policy, HIPPA, state and federal guidelines•Professional Accountabilities•Participates in continuing education, department planning, work teams and process improvement activities•Maintains current Licensure•Adheres to department and organizational policies addressing confidentiality, infection control, patient rights, medical ethics, advance directives, disaster protocols and safety•Demonstrates the ability to be flexible, open minded and adaptable to change•Maintains competency in organizational and departmental policies/processes relevant to job performance•Utilizes standards of professional practice in all communication with patients, support systems and colleagues consistent with the Board of Nursing and ethical guidelines established and universally supported by the nursing profession•Maintain utilization review data, as assigned by department.•Performs all other duties as assigned or as needed to meet the needs of the department/organization

Under general supervision, operates radiographic equipment to obtain ordered radiographs consistent with department routines and procedures. In doing so, positions patients, adjusts equipment for proper exposure settings and develops films/images following the procedure and facilitates image storage in the PACS system. Also assists physicians and Radiology RPAs in performing examinations by administering/providing contrast media and assisting with procedures as needed.This position may be eligible for a sign-on incentive, relocation, and tuition loan repayment.Essential Job Functions•Ensures radiological services provided are in compliance with standards established by Billings Clinic, local, state and federal agencies.•Performs quality procedures and radiographs using the appropriate department routine as ordered and be able to perform those examinations using all the general radiographic equipment.•Prepares the room, equipment and supplies as dictated by the particular examination or patient need and processes the necessary radiographs.•Prepares the patient for the examination by ensuring the patient is attired properly, explains the examination to the patient and transfers and positions the patient as needed. Demonstrates awareness of radiation safety for patients, self and co-workers in particular by using appropriate shielding for patients. Assists the patient at the end of the examination.•Informs Manager or Supervisor of any unusual concerns, situations or conditions relative to staff, patients and physicians. Assists with stocking and cleaning their assigned room daily. Maintains adequate inventory of all required supplies by appropriately utilizing supply management software/hardware and/or informing appropriate personnel for acquisition.•Performs a variety of clerical and image management tasks, as required, such as working up patients, completing the appropriate paper work following each examination, properly identifies exams for PACS storage and review.•Identifies need and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.•Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.•Is responsible for taking an active role in the mentoring of the student technologist staff.

May be eligible for $3,000 sign on incentiveMay be eligible for relocation assistanceMay be eligible for tuition loan reimbursementUnder the direction of department leadership, the Care Manager provides services consisting of comprehensive care management, care coordination and care continuing care services. The Care Manager is accountable for a designated patient caseload/population and plans effectively in order to meet patient needs. The Care Manager is a support to providers and the multidisciplinary in facilitating patient care. The Care Manager strives to enhance the quality of clinical outcomes and patient satisfaction while managing the cost of care.Essential Job Functions• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.• Conducts initial and ongoing assessments and chart reviews of each assigned patient to identify potential and or actual barriers and care needs.Proactively screens and assesses the acuity and transitional needs of each assigned patient.Engages and collaborates with patients, support systems and the multidisciplinary/healthcare team to establish a plan of care that addresses the mutually identified needs of the patient.• Interventions and Care Coordination• Demonstrates the ability to interpret clinical information and understand health care treatment and systems.• Supports patients to ensure they can function to the best of their ability and maintain optimal health related to their medical condition(s). Identifies and addresses gaps in knowledge/understanding/education related to disease management.• Participates in the patient's plan of care by interacting/collaborating with patients, support systems, healthcare professionals and community and state agencies. Serves as a liaison between hospital, clinic and community agencies to facilitate the exchange of clinical and referral information.• Identifies high-risk patients through risk stratification tools and ongoing assessments including ED utilization and hospitalizations to address the medical/psychosocial/financial needs of patients and their support systems in both hospital and ambulatory settings.• Reinforces goals of care and treatment plans with patients and support systems in order to enhance patient and support system engagement.• Coordinates care conferences to support effective communication as needed.• Helps navigate the patient throughout the continuum of care.• Effectively collaborates and coordinates care with the Social Services Care Manager.• Maintains current knowledge of community resources and ancillary clinical services to meet the needs of hospital, clinic and regional customers.• Provides information about available resources to patients and their support systems.• Partners with the multidisciplinary/healthcare team and the Social Services Care Manager to guide/advocate placement to the appropriate Acute rehab, LTACH, SNF, long-term care facility, assisted living facility, or Home Health Care, in-home services, hospice, ancillary OP services and/or DME as clinically appropriate.• Acts as a clinical resource to the Social Services Care Manager.• Understands consultative disciplines and their role in patient care.• Maintains respectful and professional communication skills.• Insurance and Utilization Management • Maintains working knowledge of CMS requirements and readmission penalties. • Maintains working knowledge of insurance/payer benefits.• Evaluation• Monitors the need for revisions in the plan of care and makes recommendations to the multidisciplinary/healthcare team when indicated. Modifies the plan of care/goals to reflect changes in patient or their support system status and needs.• Monitors, evaluates and documents patient progress related to plan of care.• Documentation• Documents accurately and in a timely manner in the Electronic Medical Record per program guidelines.• Utilizes standards of professional practice in all documentation and communication consistent with organization/department policy as well as the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.• Documentation and patient information shall be secured and maintained in accordance with Billings Clinic policy, HIPPA, state and federal guidelines.• Safety/Quality Assurance/Risk Management• Identifies service gaps and participates in hospital and department programs to address and improve quality of care.• Advocates for marginalized or vulnerable populations by identifying cases of abuse and neglect and appropriately involving risk management and regulatory agencies.• Professional Accountabilities• Participates in continuing education, department planning, work teams and process improvement activities.• Maintains current Licensure.• Adheres to department and organizational policies addressing confidentiality, infection control, patient rights, medical ethics, advance directives, disaster protocols and safety.• Demonstrates the ability to be flexible, open minded and adaptable to change.• Maintains competency in organizational and departmental policies/processes relevant to job performance.• Utilizes standards of professional practice in all communication with patients, support systems and colleagues consistent with the Board of Nursing and ethical guidelines established and universally supported by the nursing profession.• Performs all other duties as assigned or as needed to meet the needs of the department/organization.• Inpatient Care Management Specific• Collaborates with post-acute services, Ambulatory Care Managers and PCP's to ensure successful transition back to the home environment. Makes appropriate Ambulatory Care Management referrals. Anticipates those patients who may require more support after hospital discharge and communicates these concerns.• Utilizes length of hospital stay, past utilization of resources and risk stratification to identify patients at high risk for readmission.• Interfaces effectively with the Utilization Review department to stay current on patient's eligibility for admission, continuing stay, or readiness for discharge.• Communicates with medical staff, coordination team and nursing staff regarding appropriateness of admission, need for continued stay and discharge plans.• Identifies and records episodes of avoidable days.• Evaluates the appropriateness of care delivery in the inpatient setting and communicates any discrepancies with the medical team.• In addition to the above Care Managers in the Emergency Department will also be responsible for the following duties:• Screens ED admissions using established criteria for specific payer populations• Understands insurance/payer policy language, benefits and authorization requirements for admission• Discuss payor criteria and issues on a case-by-case basis with clinical staffEnsures that the patient is in the appropriate "status" and level of care for the clinical condition. Utilizing screening criteria and physician advisor, per department standards• Outpatient Care Management Specific• Receives referrals on patients being seen in the clinic (Primary Care, SDC, specialty office, ancillary departments). Coordinates services for medical and non-medical care coordination needs that are episodic or longitudinal.• Receives referrals for elective procedure patients who would benefit from pre-discharge planning assessments and resource coordination.• Assists patients through care transitions from hospital to home, SNF to home/assisted living, or alternate setting per program guidelines.• Manages a panel of high-risk patients that require longitudinal education and support.• Effectively collaborates with Inpatient Care Managers and Social Service Care Managers to address the needs of shared patients.• Able to function effectively as a part of a team. Utilizing shared knowledge to address complex patient needs.• Supports Billings Clinic and community-based programs to advance the role of Outpatient Care Management, strengthen partnerships and meet department and patient needs.