Utilization Case Manager RN, Decatur
SUMMARY OF RESPONSIBILITIES:
- Conducts chart assessments on hospital patients on a daily basis and documents such in Clinical Suites system; provides clinical information to insurance as requested using Interqual Criteria guidelines to establish appropriateness of admit and documents same in MS520 system. Exemplify sound clinical judgment and experience and expertise in area of clinical management and demonstrate skill in clinical chart assessment and ability to communicate effectively with physicians and staff. Communicate with precertification nurse to facilitate on going coverage and work closely with social workers to provide maximum assessment of discharge needs. Assists with providing information on advance directives and also, when asked, assists patients in formulating advance directives; provides discharge planning from the hospital setting by communicating with physician and providing information regarding Interqual Criteria and appropriate level of care. Participates in patient care conferences and communicates with staff/treatment/physician team on appropriate interventions; attends daily conference meeting with Case Management Staff to discuss patient status; and maintains positive working relationships with staff and other departments to provide optimal quality outcomes within the framework of professional nursing practice. These responsibilities are met according to hospital policy, hospital mission statement and the philosophy of the Department of Nursing. Also requires basic knowledge and operational skills of computer and office equipment; ability to move around various areas of the hospital quickly / extensive walking; possess the ability and desire to work with individual of all races, ages, lifestyles, disabilities and cultures; excellent oral and written communication skills; and must be willing to work as a member of the total healthcare team.
- Operationally, reports to the Director Integrated Clinical Documentation Improvement
- 1) Current TX RN licensure by the State Board of Nurse Examiners with basic knowledge of appropriate nursing applications 2) Current CPR
Must have current licensure/certifications upon hire.
New Hires will have 60 days to acquire the required Basic Life Support (CPR, ACLS, PALS, BLS, and/or any other life support certifications required for the job).
OSHA TASK CATEGORY THREE:
- There is no anticipated risk of exposure to mucous membranes or skin contact with blood, body fluids, or tissues, or a potential for spills or splashed during the performance of the job. Universal precautions must be observed and protective devices worn by the employee when performing a task that is likely to cause exposure.
Employment standards include current requirements as determined by Federal, State, and Wise Health System policy.
- Non-Exempt Hourly