In this role, you will evaluate ones own nursing practice in relation to professional practice standards and regulatory guidelines. Incorporates factors related to safety, effectiveness, cost, and impact on practice in planning and delivering patient care.
In this role, you will monitor medical necessity, appropriateness and efficiency of care using established inpatient guidelines, contacting Supervisor, Physician, Specialist, Hospitalist, and Medical Director as needed.
In this role, you will be responsible for reviewing and assessing the appropriateness of managed care members inpatient and outpatient medical care to ensure medical necessity and cost effectiveness under the supervision of the Medical Director through regular review of the inpatient admissions, outpatient services, discrepancies in U.M. criteria, utilization of services, and alternatives to inpatient care.
In this role, you will provide support to patients, their families, and physicians in addressing medical and social concerns; educate and empower patients and families to make informed personal health care decisions; and facilitate communication between patient, physician, health plan and community.
In this role, you will ability to manage client care with specific knowledge and experience in bedside care, symptom management, crisis intervention and family intervention are feature assets for this high-profile nursing position.