Working under department management, specializes in assessing hospital admissions for status per defined criteria and reviews for appropriate utilization of resources. Ensures continuity and coordination of care for patients before, during and after hospitalization, and ensures that payer conditions are met.
Essential Job Functions:
1. In conjunction with the interdisciplinary team supervises progress and recommends appropriate clinical interventions to nursing staff and attending physicians, ensuring CMS guidelines are met.
2. In conjunction with the interdisciplinary team ensures that patients and families have access to resources for post-hospital care needs.
3. Monitors patients' medical progress, identifies and addresses patient needs/gaps in service as they move through the system, and obtains authorization for discharge planning. Takes action to correct variances in length of stay and address them in care progression rounds and follows up with physicians and payors as needed.
4. Provides utilization reviews, meeting all time requirements and addresses the discharge appeal process in collaboration with the Dir/Mgr and/or Social Worker.
5. Accountable for following the guidelines for attendance, punctuality and overall dependability. Accountable for effective performance and follow-through of all assigned responsibilities and for completing responsibilities within designated (or agreed upon) timeframes. Completes responsibilities in a manner consistent with organizational policy, goals and values.
6. Responsible for the "Accountabilities" associated with this position in support of the organization.
7. Performs other duties as assigned.
• Must utilize one or more Cerner applications to deliver and track patient care.
• Must utilize software specific to Care Management department.
License, Certification, Education or Experience:
REQUIRED for the position:
• Current State of Washington RN license
• Bachelors of Science degree in Nursing or be actively pursuing a degree in Nursing.
• 5 years of experience as an RN with a minimum of three year's of recent acute care or case management experience
• Current Healthcare Provider BLS certification by date of hire
• Knowledge of the healthcare financial environment, reimbursement and levels of care.
• Knowledge of community resources and how to access them effectively and efficiently.
• Maturity and interpersonal skills necessary to lead and coordinate an interdisciplinary team and deal effectively with patients and families from a variety of backgrounds and with varied emotional and medical needs.
• Age-appropriate developmental assessment skills.
• Oral and written language skills; visual and aural skills in order to communicate, ensure and deliver safe patient care and to provide a legal record of this care.
• Accountability for professional nursing practice, commitment to patient care and commitment to uphold the Patient Bill of Rights.
DESIRED for the position:
• Master's degree in Nursing or other experience and /or educational preparation that would provide the foundation for Nursing Case Management