About the Job ***Work days are set for Wednesdays and Thursdays each week, experienced utilization review candidates highly preferred for this dual discharge planner/UR role*** General Summary of Position Serves as a member of the Case Management Team and applies RN clinical expertise and medical appropriateness to care coordination and discharge planning. Facilitates the delivery of quality cost effective patient-centered care from pre-admission through post-discharge timeframe.
Ensures the care is designed to meet individualized patient outcomes. Monitors the care and services delivered to selected patient populations during the acute hospital stay promotes effective case management and utilization of resources and works to achieve optimal clinical and resource outcomes for the acute and post-hospital phases of care. Primary Duties and Responsibilities Contributes to the achievement of established department goals and objectives and adheres to department policies procedures quality standards and safety standards.
Complies with governmental and accreditation regulations. Collaborates with the multidisciplinary health care team to develop and coordinate the plan of care. Communicates with patient family and/or significant other health care team external case manager community resources and facility to address appropriate issues and patient/family goals.
Demonstrates the ability to develop a plan of care that addresses needs across the continuum; have an intervention for problems identified; develop long- and short-term goals with specific time frames for resolution; identify specific services to be provided in the care plan; include the family/care-giver in the plan of care; and show life planning contingencies such as power of attorney and/or advance directives. Evaluates and documents the patient's response to the plan of care and achievement of outcomes.
Makes recommendations for modifications to the plan of care as indicated. Adheres to all policies and procedures regarding documentation and confidentiality of information. Maintains knowledge of regulatory agencies' requirements necessary criteria for admission to various care settings and Medicare's/Medicaid's reimbursement methods for different levels of care.
Manages a caseload of patients. Identifies essential resources needed to implement the plan of care. Manages own professional growth in the area of managed care care management other health care financial trends clinical practice and research.
Manages patient care according to multidisciplinary plan of care and/or managed care contracts by directing decision making and identifying and managing barriers that impact on patient care outcomes. Participates in Performance and Service Improvement teams. Assists in program evaluation through customer service surveys LOS data analysis charge/discharge data comparison to state averages and best practice/benchmark data.
Performs a comprehensive assessment in collaboration with interdisciplinary team to identify patient-specific problems and needs related to diagnosis treatment including psychosocial and financial concerns as well as medical. Minimal Qualifications Education Associate's degree in Nursing (ADN) required Bachelor's degree in Nursing (BSN) preferred Experience 2-3 years of clinical experience required 1-2 years case management experience preferred Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure in the District of Columbia or Maryland depending on work location required CCM - Certified Case Manager preferred Knowledge Skills and Abilities Ability to use computer to enter and retrieve data.
Working knowledge of Microsoft Word Excel and PowerPoint applications. Effective verbal and written communication skills. Must be able to run and analyze departmental productivity reports.
Excellent interpersonal skills required. This position has a hiring range of USD $89,065.00 - USD $162,801.00 /Yr.