Clinical Resource Mgmt Nurse / Clinical Resource Management

Hartford Healthcare•Wethersfield, CT

About The Position

The Clinical Resource Management Nurse is an integral part of the Care Management team whose focus is on performing a timely level of care assessment ideally at the immediate point of entry into the health system to ensure that patients are assigned the most appropriate patient class based on their clinical needs incorporating the judgment of their provider. The Clinical Resource Management Nurse is able to work autonomously and swiftly, managing a high volume of complex cases across all HHC system hospitals.

Requirements

Registered Nurse is required.
Current State of Connecticut RN license
Familiarity with clinical care
Able to influence and negotiate
Critical thinking, astute assessment and confident in decision making
Strong interpersonal and communication skills
Knowledge of Interqual or equivalent criteria and reimbursement guidelines
At least five (5) years of relevant clinical experience.

Nice To Haves

BSN in Nursing is preferred
Acute care or managed care utilization review is preferred.

Responsibilities

Apply standard criteria and guidelines to assist in determining and/or to validate the patient class assigned by the provider.
Document review and findings as well as any additional information relevant to the case as directed and appropriate.
Partner with the Emergency Department and/or the Admitting Provider to ensure the patient class assigned is appropriate given the patient’s clinical presentation.
Act as a resource and subject matter expert to the Emergency Department and/or the Admitting Provider on aspects of patient class and level of care determination.
Escalate cases to designated Physician Advisor resource when assigned level of care is not appropriate and Emergency Department or Admitting Provider is unwilling to consider recommendations for alternative.
Maintain knowledge of industry standards and regulatory requirements which influence patient class and level of care determinations.
Provide education sessions to constituency groups as needs are identified and/or as requested.
Support needs of the department in the event of a critical demand or a decrease in volumes by performing a review of work ques, crafting appeal responses, etc.
Ensure any information critical to the care and progression of the patient gleaned during the review process is relayed to the Care Manager responsible for the patient.
Complete assignments to demonstrate expert knowledge of criteria as requested.
Other duties as assigned.