Utiliz Review Specialist

Location
Katy Hospital, Katy, Texas
Salary
Competitive
Posted
Dec 06, 2017
Closes
Dec 14, 2017
Specialty
Other
Contract Type
Permanent
Hours
Full Time
Utiliz Review SpecialistKaty Hospital

Job Description
Position responsible for the clinical appropriateness (utilization) review of inpatients and observation patients in assigned area for appropriateness of admission and patient placement. Utilization reviews may extend through continued stay and involve discharge planning activities under the direction of an RN Case Manager.

MINIMUM QUALIFICATIONS:

Graduate of an accredited School of Nursing (RN) or vocational nursing (LVN) with license to practice in Texas.

2-3 years of clinical experience

Current State of Texas Licensure

Prefer 2-3 years experience in Quality Assurance or Utilization Review or Discharge Planning

Demonstrates commitment to the Partners-in-Caring process by integrating our culture in all internal and external customer interactions; delivers on our brand promise of “we advance health” through innovation, accountability, empowerment, collaboration, compassion and results while ensuring one Memorial Hermann.

Principle Accountabilities:

Review all admissions/internal transfers for appropriateness of admissions using approved criteria.

May extend clinical appropriateness reviews through continued stay, under the direction of an RN Case Manager.

May assist the RN Case Manager with discharge planning activities of identified high risk patients and surveillance for patients requiring discharge planning referrals, assistance obtaining durable medical equipment and other discharge planning activities. Review and interview high risk patients and families to screen for discharge needs.

May consult on disasters, code 3s, staffing issues/concerns in relation to bedding patients and administer/communicate census.

Take appropriate follow-up action when established criteria for utilization of services are not met.

Identify patient populations and monitors to assure that appropriate placement is secured.

Maintain appropriate documentation of clinical appropriateness reviews performed.

Act as liaison with physicians and collaborates with health care team members in patient management rounds.

Approve cross service patient movements.

May secure appropriate referrals to social service, Home Health Services, SNF and other alternate care services at the direction of an RN Case Manager.

Ensures safe care to patients, adhering to policies, procedures, and standards, within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.

Promote individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.

Other duties as assigned.

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