Conducts complete assessments, establishes appropriate plans, and initiates interventions within desired timeframes.
Collaborates with patient, family, and healthcare team to achieve patient and organizational goals related to care needs, discharge planning, and transition.
Utilizes patient/family strengths in problem-solving, involving the patient/family and team in decision-making from admission through hospital stay.
Provide continuity of care and discharge planning services compliant with regulatory standards; offer coordinated options based on assessed needs.
Participate in communication to facilitate smooth transitions when patients are transferred.
Provide case management for issues such as health care access, finances, housing, family dynamics, or illness adjustment; manage crisis situations using community resources and educate patient/family on service access.
Initiate internal and external referrals to ensure timely progression of care and transitions.
Document discharge planning interventions and utilization review activities per department/medical center standards in a timely manner.
Perform concurrent and retrospective reviews per established criteria; communicate effectively with the healthcare team.
Collaborate with Social Work and unlicensed staff to implement a safe plan of care.
Serve on the Outcome Facilitation Team/Patient Care Multidisciplinary Team to identify and resolve discharge barriers and expedite care delivery.
Collaborate with managers, physicians, and treatment teams on best practices for the patient\'s plan of care; refer cases to physician advisor as needed.
Remain knowledgeable about healthcare regulations, reimbursement, length of stay, and community resources.
Complete Utilization Management (UM) activities, including clinical updates to payers, data collection, denial coordination, and managing avoidable delays.
Deliver CMS regulatory notices within CMS timeframes as appropriate to on-site guidelines.
Develop and maintain productive relationships with community-based agencies and networks to meet patient/family needs.
Educate staff on admission status, acute care criteria, utilization management issues, care coordination, discharge planning, and regulatory requirements.
Demonstrate knowledge to provide care appropriate to the age of patients served.
Qualifications
License/Registration/Certification: Registered Nurse License issued by the state of practice.
Education: Bachelor’s Degree in Nursing.
Experience: 2 years of clinical nursing experience.
Knowledge, Skills, and Abilities:
Ability to prioritize and organize work; effective communication; critical thinking and timely decision making.
Ability to navigate the Electronic Health Record; basic MS Office skills.
Knowledge of Medicare A and B guidelines; knowledge of Managed Care program requirements/implications.
Ability to apply elements of Utilization Management programs.
Physical Requirements: Sit up to ~50% of the workday; lift up to 50 lbs intermittently; manual dexterity for computer/ calculator use; good vision and hearing for accurate documentation and communication.
Job Details
Seniority level: Not Applicable
Employment type: Full-time
Job function: Other
Industries: Hospitals and Health Care
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