Proposal for Services
A. Managed Healthcare Solutions
Customized With You In Mind...
JRN CONSULTING is a behavioral health contractual care organization, a professional claim and benefit administrator. JRN is not an insurance company. Our focus is on reducing the cost of healthcare without sacrificing the quality of care.
Financing healthcare is costly today. Being a diversified organization, the professional staff at JRN understands the goal of giving employees and their families an affordable, quality healthcare program.
We offer a comprehensive array of products and services to our clients nationwide, both large and small, at significant savings, including benefit package designed to fit your specific needs.
The uniqueness of our organization comes from the individual talents and personalities within. That is why JRN focuses on the personal relationships we can develop with you and your members. We will work with you to create ways to control your healthcare costs.
B. Behavioral Health Plan Administration
Professional Claim & Behavioral Health Plan Administration...
Professional Claim and Behavioral Health Plan Administration is a complex function and are often overlooked as a critical part of a contractual care program. Due to an underestimation of Behavioral Health administrative functions, many payers fail to consider the use of an outside administrator. External administration may allow you to budget operational expenses more effectively, lower cash outlays, reduce space, avoid additional hardware and software requirements, limit staffing requirements, and allow you the opportunity to focus on the quality of the healthcare services being delivered as well as meeting all HIPAA and ERISA requirements.
As a Behavioral Health Plan Administrator, JRN provides professional claim and Behavioral Health Plan administration to clients, assisting with the design, interpretation, and coordination of their members benefit programs.
- The elements of our professional services include:
- Behavioral Health Benefit Consulting & Interpretation
- Claims Adjudication and/or
- Claim re-pricing/Payment (when applicable)
- Behavioral Health Coordination of Benefits
- Authorization of Services
- Member Eligibility Verification
- Sophisticated Statistical Reporting
- Customer On-line Availability
- Behavioral Health Plan Documents
- Summary Plan Descriptions
JRN is able to provide you with these services from a staff of professional quality-conscious individuals who take pride in providing the best possible services to our clients.
C. Preferred Provider Organization:
Caring, Choice & Cost Containment...
JRNs Preferred Provider Organization (PPO) develops and monitors networks of healthcare providers that provide their services to group health plans in a quality, convenient, and cost-effective fashion.
The JRN CONSULTING proprietary provider network includes hospitals and other major facilities, a wide range of the most qualified physicians and other Behavioral Health licensed specialists. For those clients with a workforce throughout the United States or for those retired members who have relocated to a warmer climate, JRN has access to numerous PPO Networks nationwide or will develop custom regional networks of our own.
Participating providers have agreed to accept our negotiated rates for payment in full for covered services. Therefore, hospital and physician charges are reduced when members use network providers.
In addition, members do not have to worry about filing their own claims. Our participating providers have agreed to submit claims directly to JRN for re-pricing according to the discounted fees. The claim is then forwarded to the responsible party for payment or directly to the provider when applicable.
JRN is not only committed to containing healthcare costs but to preserving excellent patient care standards. All participating providers must meet stringent credentialing standards, including initial and annual credentialing reviews.
Our PPO services and standards will complement any group health plan.
D. Utilization Management:
Encouraging Appropriate Care.
Utilization Management means the planning, organizing, directing, and controlling of the healthcare product to assure cost-effective, high-quality care while contributing to the overall goal of patient wellness. This is accomplished through the judicious use of resources on an ambulatory as well as inpatient basis.
The Utilization Management process evaluates the appropriateness of behavioral healthcare to clinical criteria. Effective utilization management will lower costs and increase the quality of care as unnecessary treatment is eliminated. It will also maintain quality of care by assuring that services provided are of suitable duration, frequency, and level of care to promote an optimal health outcome.
A Patient Care Coordinator works with the Director of Clinical Services in order to coordinate the following activities of utilization management:
This is an assessment of a providers plan of treatment and/or procedures prior to a patient receiving services. The assessment provides assurance of the appropriateness of the provider, facility and treatment selected.
Inpatient Case Management:
The Patient Care Coordinator coordinates with the attending Clinician to assure continuity of care and delivery of medically necessary patient services. The case manager also insures that the patient receives from the facility all appropriated contracted services. They evaluate and conduct concurrent review and discharge planning as an underlying system essential to assure that all medically necessary services are provided both efficiently and economically.
Medical Claims Review:
This review evaluates the overall medical appropriateness of services rendered, including procedures or diagnoses, as well as an in-depth review of physicians practice patterns.
E. Critical Incident Debriefing:
It is recognized that certain critical incidents can create added stress, such as gruesome deaths, hostage situations, natural disasters or suicide, to name a few. The stress from these events has the potential to significantly influence the behavior and emotional well being of any individual. In order to better serve your employees/members. We have the ability to access an array of professionals who are specifically trained to provide critical incident stress debriefing and counseling to employees involved in any such incident.
F. Customer Service:
Friendly, Responsive, Courteous...
We are proud of our customer service representatives ability to develop close and friendly relationships with our customers. We are a service organization and continually strive to place the quality of our service above all else.
We also understand that the healthcare services we provide to your members, our prompt attention to their claims, and our responsiveness to their individual needs reflect directly on you as the purchase of our services.
Our most important job is to make sure that your participants know you have made a sound decision in selecting JRN Consulting, LLC.
G. Educational Programs:
Our educational in-services are employed by many organizations to educate managers, supervisors, administrators, etc... , regarding pertinent personnel issues, current management trends as well as a variety of skill development programs.
- Signs and symptoms of behavioral health and substance abuse problems
- Motivational Leadership Procedures for dealing with the distressed member/employee
- Communication Skills
- Time Management Techniques
- Avoiding Burn Out
- Sexual Harassment in the Workplace