Genfinity Clinical Programs
.
Peer Review
Post- Hospital Discharge Calls
Live Nurse Chat
Peer Review
Determine the medical necessity and appropriateness of procedures following:
o Clinical criteria guidelines such as Milliman or
o Specific state-mandated guidelines
o Health insurance specific guidelines
Provide evidence-based medical recommendations to US-licensed Medical Reviewers who are responsible for the final sign-off of the cases.
Benefits:
· Augmenting the peer review process for Utilization Review by having the initial review done by the offshore Medical Doctors
· Increased productivity, increased number of completed cases of US-licensed Medical Reviewers
· Cost-effectiveness
Post- Hospital Discharge Calls
Best in the Industry
· Check current health status since transitioning to home care
· Ensure understanding and compliance with discharge plan provided by healthcare provider
· Identification of patients who would require additional guidance re: their recovery, extend care or support after hospitalization.
· Ensure compliance with scheduled follow up medical appointments
Benefits:
· Effective transition and continuity of care from hospital to home setting
· Decreased risk of re-admission, medication non-compliance and adverse drug events after discharge
· Prevention and early detection of complications
· Patient satisfaction that leads to better risk management
Live Nurse Chat
Philippine Licensed Registered Nurse provides online chat support for a US based health insurance to help patients by:
Answering non-emergency health related questions of patients 24/7
Providing guidance to online resources available to help with medical concerns
Referring to a 24/7 nurse line as part of their health benefits
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam eu dignissim tortor, sit amet bibendum lacus. Lorem ipsum dolor sit amet.
Benefits:
· Initial screening of health questions ensuring appropriate utilization of the nurse line
· Maximation of health insurance benefits resulting to better patient/consumer satisfaction
· Better consumer support compared to automated responses by enabling meaningful interactions through messaging-based communication and continuity of information remains intact, regardless of how the patients engage.
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam eu dignissim tortor, sit amet bibendum lacus. Lorem ipsum dolor sit amet.
Nurse Concierge/Case Management Support
Team of Philippine Licensed Nurses that support US-based Case Managers for a Worker’s Compensation insurance by integrating their clinical expertise and administrative skills.
Screening of injured workers by utilizing clinical judgment to identify and enroll into Case Management which is done by connecting with the patient to collect critical medical information such as injury severity and treatment plans
Review and create concise medical abstracts to be provided to the US based Case Managers
Benefits:
· Proper enrollment and utilization of Case Management Program
· Enhanced patient care by reducing the administrative responsibilities of the CM nurses, allowing them to focus on direct patient care and interaction.
Virtual Safety Companion
Philippine Licensed Nurses act as virtual sitter for high risk admitted patients from different hospital facilities in the US to minimize the risk of fall and any untoward incidents by:
· 24/7 continuous falls monitoring
· Early intervention opportunities by patient redirection and alerting a bedside nurse or staff
· Standard safety rounding
· Staff safety monitoring in the case of combative or aggressive patients and/or family members
Benefits:
· Enhanced patient safety resulting to decreased number of falls and untoward incidents such as IV pull, line infections and hospital acquired pressure ulcers
· Early detection of untoward symptoms by utilizing nurses as virtual sitters
· Reduction in the need of 1:1 physical sitter, ultimately decreasing labor costs
· Better employee and physician satisfaction leading to significant reduction in staff turnover and overtime
· Staffing optimization
· Improved patient care quality and satisfaction
· Cost reduction
Genfinity Clinical Training Department
Comprise of both healthcare professionals including Philippine and US registered nurses that provide comprehensive and effective training and support to various Clinical programs by:
· Client certification – Our clinical trainers have successfully completed comprehensive client certifications prior to the initiation of any clinical training programs. This ensures that they are fully equipped with the necessary knowledge, skills, and expertise to provide high-quality, tailored training aligned with client-specific protocols, standards, and expectations.
· Development and conduction of training programs
o Design and implement clinical training programs that would cover essential skills and best practices for healthcare professionals
o Ensuring the training programs are aligned with industry stands and client specific protocols
o Update training materials regularly to reflect any process changes or updates
o Facilitate face to face or virtual training session for healthcare associates
· Program Immersion – trainers are immersed in the clinical projects regularly ensure up to date information and process knowledge
· Clinical Module Development – Creation of training materials tailored to specific healthcare projects
· Competency Assessment
o Evaluation of healthcare associate through written examinations, simulations and practical assessments
o Certification of staff upon successful completion of the training program
o Provide additional training sessions or support as needed to ensure all team members are able to meet the required competency level.
Utilization Management Nurse
· US Registered Nurses who are responsible in providing utilization management services for clients, insurers and patients to promoted quality medical care in prompt and cost-effective manner by ensuring all services and/procedures requested are deemed medically necessary by utilizing approved clinical criteria guidelines.
Utilization Management Intake Support
· Utilization Management Intake Support – Philippine Registered Nurses that provide intake support to UM nurses by preparing and collecting necessary medical information needed prior to case creation and review.
Revenue Cycle Management
o Group of Healthcare Allied professionals that provide end to end support for medical claims management that includes:
· Claim processing and submission to respective payers or clearing houses
· Payment reconciliation including follow ups and posting
· AR follow ups both for payers and patient responsibilities