A CEO’s reflection as a floor nurse As a young Nursing graduate back in 1990, I enthusiastically repeated the Nightingale pledge with every ounce of sincerity my 24-year-old self could muster. In my lofty ideals, I intended to treat every patient as though he or she were a personal family member, and so I did,…
Top HEDIS scores come from Top Nurse Reviewers! PSN’s focus on managed care offers clients an outstanding network of nurses, RNs and LPNs, qualified for medical chart review and data abstraction projects. Our nurses have completed HEDIS for health plans, mortality studies and billing reviews for hospitals, and EPSDT state audits of childhood health screenings for Medicaid…
Client’s Challenge: In May of 2015 a large Health Plan approached PSN with an immediate and critical need to fill 200 utilization review nurse temporary positions throughout the U.S. The client had secured a contract that required that these utilization nurses be fully operational within a three month time frame, and desired that as many as…
Thanksgiving began as a day of giving thanks for the blessing of the harvest- a tradition that has continued for most years since the first colonists in Plymouth Massachusetts shared their first food harvest with the Indians. Americans carry on the tradition of celebrating the bounty of food with their families and friends each year…
What employers consider when searching to fill a remote opportunity. Telecommuting opportunities are increasing for professionals in many fields. Nurses, in particular, have access to many jobs that allow telecommuting as health care companies try to provide both excellent service and cut costs. Professional Services Network, Inc. recently had the opportunity to work with a…
It is easy for patients to get lost along the road to recovery. With all of the confusing directions and potholes along the way, it is difficult to figure out the best path to take. Case Managers are the personal guides that help patients navigate health care. Case Managers work with patients as their advocate…
Today’s Case Manager role is multidimensional and pivotal for many reasons – the healthcare landscape continues to evolve, discharge planning and transition from episode of care to community to reduce readmissions and improve patient experience is a must , financials of care need to be addressed as there is not an open checkbook – insurers…
Case management is an essential process being used throughout the healthcare system to improve quality and reduce costs. Professionals who work in case managers are primarily nurses and social workers, but depending on the setting, other professional disciplines are joining the practice. These include, physical, occupational, speech, respiratory therapist as well as psychologists and behavioral…
Collaborative Case Management is emphasized by accreditation organizations such as URAC and also by national case management standards of the Case Management Association of America. Collaborative case management involves a plan of care developed with the patient and emphasizing patient- centered services. It is a useful method that demonstrates both a cognitive reasoning approach and documentation required by URAC…
The process of utilization review can start at any point along the continuum of needed services. Utilization review coordinators who maintain an active healthcare license, i.e. registered nurses or licensed social workers, conduct utilization review in hospitals, or telephonically and on-site for managed care organizations. Concurrent utilization review takes place while a patient is receiving…
Our last URAC Blog addressed changes to the Delegation Standards. We want to follow up on that with information from the URAC August 23rd Webinar on the Delegation Standards changes. There are some changes that need to be emphasized. There are changes in definitions, and three of the important ones are as follows: Contractor (revised…
Navigating beyond the glitz of innovative telemedicine technology requires understanding the essentials of telemedicine programs. The basic technology involved includes the tele-platform, the communication media, and software. The recent improved reimbursement of telemedicine by Medicare, private payors, and some Medicaid programs is a call to action for health delivery systems to develop these services or…
Are you a Registered Nurse looking for a new opportunity to utilize your clinical nursing skills? Are you interested in healthcare quality and cost issues? Utilization Review (UR), an aspect of managed healthcare, may be of interest to you. Whether UR nurses work in hospitals, home health, outpatient settings or in insurance companies or other…
As a manager, do you ever wonder why you need to continually remind your staff what it is they are supposed to do? You give them job descriptions, policies, desk-top procedures, detailed instructions and yet many still stray from these directives and fail to meet basic job requirements. It’s an exhausting cycle for both the…
Since the early 1990’s, “eHealth” has continued to grow in prominence. E-health encompasses a wide variety of consumer or patient accessible information. Some examples include telemedicine that includes long distance medical diagnosis and treatment, and electronic health records (EHR) that allows archiving and transmission of patient data between health providers and patient education. The broad…
Twenty-five years… a long time and a split second. A quarter century ago(!), Professional Services Network, Inc. (PSN) was born, offering temporary managed care staffing to companies in the Washington DC area. Today, we also offer direct hire positions and provide expert consulting in NCQA and URAC accreditation support. And we work throughout the U.S.…
Happy National Nurses Week 2019 As we celebrate National Nurses Week, it is important to remember that Florence Nightingale helped reform nursing in the mid-19th century by her compilation and creative presentation of statistics. Her investigative statistical work led to a decline in the many preventable deaths that occurred throughout the nineteenth century in English…
The term “eHealth” started appearing in 1990’s and grew in prominence with the technological advances of computer age and the wide availability of computer resources. In general, the term “eHealth” refers to interface of healthcare, computer science, and information science. Ehealth solutions encompasses number of categories of patient-related information, including but not limited to the…
According to a study by a popular career site, healthcare tops the five job categories with the most work-from-home jobs. That’s great news for healthcare employees who want the convenience and cost-savings associated with remote work! Estimates by Global Workplace Analytics, a consulting company promoting the benefits of telecommute work to employers, suggest that telecommuting has…
According to the NCQA, the Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. HEDIS was designed to allow consumers to compare health plan performance to other plans and to national or regional benchmarks.…
PSN is dedicated to providing strong expertise in NCQA – focused consulting. Our NCQA consultants have actual experience as NCQA surveyors… We are very focused in providing only the best qualified consultants in any of our accreditation – related consulting services in order that clients are successful! Our NCQA consultant team have more than 26 years…
Personality / Aptitude Testing: The best way to hire the right candidate…or is it? What is it like to interview for an employment opportunity in today’s market? What can you expect? There are some experts in the Human Resource (HR) industry today suggesting as much as sixty percent of the work force is now being…
Quality Management leader Peter Drucker coined the phrase “if you can’t measure it, you can’t change it ” to drive home the point, that if we want to improve, we need to know where we are and where we want to go. This has never been as true as it is in the broad healthcare…
Did you know? 2.91 million people are employed by staffing companies every business day. It’s how organizations cope with the need for qualified staff – whether to fill in for current employees on leave, accommodate additional work demands, or provide resources for vacant positions while recruiting. PSN can provide great experienced nurses, case manager social…
By Anne Llewellyn, RN-BS, MS, BHSA, CCM, CRRN As we moved to a value-based health care model, organizations and providers are being evaluated and paid relative to the health outcomes of the population they serve. As a result, many are rethinking how they practice and are making changes to be more in tune with the…
Inc. magazine named Professional Services Network, Inc. (PSN), a nurse-owned Maryland-based managed care staffing and consulting company, to the Inc. 5000 listing of the fastest-growing companies in the nation. The Inc. 5000 list represents the most comprehensive look at an important segment of the economy—America’s independent entrepreneurs. PSN, founded over 30 years ago, has seen extensive growth over the…
The holidays are soon among us and with it can bring a flurry of emotions (as well as a few “snow” flurries in the forecast as well!) The stress of holiday preparedness, coupled with the joy of being with family or the sadness of missed family members, is omnipresent as we wind down yet another…
October 09, 2017 Case Managers are the guides that help patients navigate in this quickly changing and extremely complicated world of health care. They are the patient’s advocate. The case manager helps the patient understand their own needs and then makes sure the patient gets what is needed. They do all this and also work…
Nurses are the backbone of the healthcare system, yet, many times we wonder if anyone notices. Well last week, Jimmy Kimmel, shared a personal story with millions of viewers about an attentive nurse who noticed his newborn baby boy had a problem. As she performed the newborn assessment, she noted that the baby had a…
If you are thinking about NCQA accreditation or reaccreditation, PSN can help. Preparation for an NCQA accreditation or certification survey can be a struggle, but these three action items can dramatically reduce the preparation difficulties and increase an organization’s likelihood of success: Provide adequate resources: The NCQA standards not only address quality improvement, but they also address…
The NCQA Patient Centered Medical Home is a voluntary recognition program for physician practices that provide a medical “home,” or coordinating point, for their patients. Building on the joint principles developed by the primary care specialty societies (American College of Physicians, American Academy of Family Physicians, American Academy of Pediatrics and American Osteopathic Association), the NCQA Medical…
Population Health Management (PHM) Beginning to prepare for an NCQA Accreditation Survey, requires one to see that NCQA now has a module of Population Health Management (PHM). Why is it important to know about the population in an organization or in a practice? What does Population Health mean? Population Health is an approach to health…
By Jean Lockington, MA, RN, PLNC, PCMH CCE For NCQA accreditation, there is often a requirement to submit a report that includes a quantitative and qualitative analysis. Where does one begin? At times organizations prepare a report that shows data in a graph/grid format, comparing data from year to year. Presenting data in this format alone does…
As professionals, Registered Nurses have an obligation to know and follow the licensure requirements set by the state Board of Nursing in the states in which they practice. In the past, this was fairly easy as most nurses practiced in the state where they lived. Today, due to the focus on cost containment and advances…
A company has many opportunities to produce a quality service or product. Choices in materials, choices in training procedures, choices in people. Nurses have similar choices to make – for whom to work, how diligently to do a job, when to escalate a problem. October 18th through 24th is National Healthcare Quality Week. Sponsored by…
Professional Services Network, Inc. (PSN), a woman-owned, nurse-owned healthcare staffing, recruiting and consulting company, has been selected as one of the top 50 woman-owned businesses in Maryland by DiversityBusiness.com. In addition to this year’s honors, PSN has maintained rankings in the Top 100 Woman and Diversity owned businesses for two prior consecutive years. CEO and…
As a professional Case manager, you have many resources that can assist you to practice in a safe, ethical and effective manner. This post will highlight a few of the resources you can use so that you are working in compliance with your area of practice. We have an obligation to be aware of the…
Even nurses, with their excellent job prospects, can have difficult job searches. A decent resume can get you in the door for an interview. A poor one can sink an otherwise promising relationship with an employer. Through our experience at PSN, we know what works and what does not for applicants seeking direct hire or…
Utilization Management (UM) nursing has generalized standardized job roles and tasks, and the role is complex and varied with many specialties and subspecialties. As a UM Quality Manager, I’ve been involved with UM nursing programs in every area of inpatient and outpatient health care. My experience in UM specialties has included maternity/delivery, child development, bariatric,…
It has been interesting to observe the role of the nurse case manager and utilization review nurse over the past two decades. Case manager and utilization review roles have distinct yet complimentary functions and responsibilities in the health care delivery system. However, nurses who seek temporary assignments as case managers and those returning to the…
I want to remind you to stay aware of changes related to the new CORE 4.0 standards. A recent communication from URAC advised that they were going to suspend additional rollout of CORE v.4.0 to programs other than Case Management. URAC will use Case Management as a test group to determine the impact of Core…
As a healthcare provider or organization, you may find yourself at some point needing to become accredited. Whether it may be to meet state-mandated regulatory requirements or to satisfy specific contractual requirements with other parties, pursuing accreditation might become a reality for your organization. At first this can be very overwhelming and quite challenging as…
Patient Centered Medical Homes – Why they are important and the benefits of achieving recognition. November 22, 2017 Over the past seven years, accreditation focus of The Patient Centered Medical Home model (PCMH) has grown in popularity, fueled by evidenced-based results across three domains: reducing cost, improving quality of care, and rightsizing utilization. Physician practices…
The nurse seeking employment in today’s job market must realize the hiring process is competitive. The nurse seeking employment is competing against other qualified nurses and in a sense, against technology. Nurses must now submit resumes and applications electronically. These resumes and applications are sorted, ranked and pre-qualified by computer systems based on keywords that appear…
Professional Services Network, Inc.(PSN) is pleased to present you with tips from a NCQA accreditation consultant. The information is intended to help those seeking accreditation to better understand the challenges that are often encountered within an organization and how to best navigate toward the goal of accreditation. We posed some specific questions to our consultants.…
We will guide your preparation for URAC Accreditation! Professional Services Network provides expert consultation to companies seeking accreditation with the American Accreditation Healthcare Commission/URAC. We provide high-quality consultative services and assistance with program development in a cost-efficient manner to meet YOUR time requirements. We provide expert accreditation preparation services in any of the following areas:…
The goal of this Blog is to provide information professionals and employers involved in medical management can use to meet the demands of today’s complex and disruptive healthcare system. One writer who you will hear from is Anne Llewellyn, RN-BC, MS, BHSA, CCM, CRRN, often referred to as the “the Case Manager’s, case manager”. She…
Where to Get Started with NCQA and the PCMH Recognition Process? Where do I begin? The process for preparation can be very overwhelming so here are a few key tidbits!! Be sure to obtain the most current standards which at this time is the 2017 NCQA PCMH Standards; begin to review the standards, see what…
No one graduates from a baccalaureate program in nursing today without at least one course and many instructor reminders about the importance of evidence-based practice (EBP). Modern computer programs have simplified the scientific process, allowing for easier data storage and analysis, resulting in the availability of faster results from studies. So, not only do we…