Case Manager PRN

Conway Regional • Conway, AR

2d

About The Position

Provides discharge planning and utilization review services in accordance with patients’ discharge planning needs and the hospital’s utilization review program. This is a safety-sensitive position designated under Act 593 of the State of Arkansas. The posting states that an employee under the influence of marijuana constitutes a threat to patients or customers in the delivery and support of health care services.

The role analyzes patient information to determine whether admission or continued stay is necessary, reviews acuity and utilization using approved criteria, and coordinates discharge needs with the healthcare team. It also supports the utilization review process through documentation, appeals, staff education, policy development, and collaboration with hospital departments and external review agencies.

Requirements

• Current, active Arkansas license as a Registered Nurse or Licensed Practical Nurse.
• Proof of the highest level of nursing education achieved.
• At least one year of experience in case management or utilization review is preferred.

Nice To Haves

• At least one year of experience in case management or utilization review.

Responsibilities

• Apply clinical knowledge to determine appropriate acuity levels and utilization through chart review.
• Organize workflow to complete assignments in a timely manner.
• Access and effectively use primary sources of data.
• Obtain and maintain medical records in accordance with Medical Information policies.
• Communicate respectfully and effectively with co-workers and other service providers, demonstrating honesty and integrity.
• Comply with hospital, state, and federal requirements for maintaining confidentiality of persons, data, and information systems.
• Pursue professional growth and development opportunities offered by CRHS and other professional organizations.
• Analyze patient information to determine the necessity of admission or continuation of stay.
• Review admission for medical necessity on the first working day after admission using approved review criteria.
• Review inpatient procedures to determine appropriate utilization and acuity level, including potential use of an outpatient setting or swing bed.
• Review patients for medical necessity of continued stay, or before the next review date, using approved review criteria.
• Perform retroactive reviews as necessary and respond to the appropriate review agency or third-party payor.
• Research denials issued by review agencies and third-party payors and respond within specified appeal time frames.
• Coordinate patients’ discharge needs with other members of the healthcare team.
• Establish and maintain an effective utilization review process and file system; recommend, develop, and revise related policies.
• Collaborate with physicians, Case Management, discharge planning, Admissions, Central Scheduling, and other CRHS associates.
• Educate staff, physicians, and other personnel about medical necessity requirements defined by approved review criteria.
• Assist with other department functions as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed