RN Case Manager - Medical/Surgical - Livingston HealthCare

JOB SUMMARY:

The Discharge Planner/Utilization Review RN conducts admission, concurrent with retrospective utilization reviews for all assigned patients. This individual communicates with payors, physicians and the Director of Nursing to facilitate appropriate admissions and discharges, and to promote a high quality of care while preventing under-utilization and over-utilization of hospital resources. This person conducts discharge-planning activities for assigned patients and completes data collection This person also is responsible for an active utilization review of all patient admissions and discharges, collaborates and facilitates on all Swing Bed admissions, maintains an active re-admission review program, and works closely with the Director of Nursing and the Nursing Leadership team to improve patient outcomes.

Schedule:

• PRN
• Variable Hours

Compensation:

• $33.79 + DOE
• Shift Differentials
• PRN Differential

ESSENTIAL FUNCTIONS, DUTIES, AND RESPONSIBILITIES:

1. Assesses patient’s needs and options for discharge planning. Interviews patient and family to determine medical social needs and identify available resources.
2. Implements a discharge plan in conjunction with the patient and family to assist in achieving optimal resolution of needs and problems.
3. Promotes participation of the patient and family in development of the discharge plan.
4. Maintains communication with a multi-disciplinary team related to discharge planning.
5. Coordinates appropriate referrals and maintain relationship with referral/community services.
6. Assist in placement of patients in a skilled nursing facility, rehabilitation center, or hospital providing special services.
7. Conducts chart review to analyze clinical data and record and submit to regulatory agencies, PIN.
8. Reviews medical records concurrently for medical necessity, intensity of service, and continued stay review.
9. Works with the Clinical Resource Nursing, Staff Development RN, and Nurse Managers to ensure optimal outcomes on all patient admissions and discharges.
10. Works in conjunction with medical staff on appropriate discharge planning and admission status, educating physicians when appropriate
11. Conducts regularly scheduled utilization review meetings, maintaining agendas and notes, identifying opportunities for improved revenue opportunities.
12. Conducts monthly re-admission analysis and chart reviews, reporting to the Director of Nursing and an established re-admission work group on opportunities for improvement.
13. Works with Nursing Leadership on quality improvement programs and patient satisfaction improvement projects.
14. Insures over-all compliance with CMS standards for Discharge Planning and Utilization Review.
15. Attends meetings of staff, medical staff, and board as required.

ADDITIONAL RESPONSIBILITIES:

1. Advises the Director of Nursing on discharge planning and utilization review.
2. Maintains current understanding of changing utilization review requirements
3. Develops networking opportunities for patient growth within the industry.
4. Works in conjunction with all QI/PI projects.

QUALIFICATIONS (Required):

1. Current Montana R.N. license.
2. Associate Degree in Nursing/ BSN preferred.
3. 5-10 years acute care experience.
4. Training in patient assessment and identification of patient needs.
5. Background in public health, social work, or home health.
6. Effective verbal and written communications skills.
7. Ability to read and write and follow oral and written instructions.
8. Ability to form effective working relationships with a wide variety of hospital and community resources.
9. Ability to function independently with minimal guidance.
10. Working knowledge of Microsoft Office, Excel, PowerPoint.
11. Current Basic Life Support certification.

ADDITIONAL DESIRABLE QUALIFICATIONS:

1. Previous discharge planning or case management.
2. Leadership or management skills.
3. QI/PI, or CMS review.