Discharge Planning and Utilization Review Nurse

Gritman Medical Center•Moscow, ID

About The Position

Promote the mission, vision, and values of the organization along with the Gritman Way. Conduct comprehensive evaluations of patient’s medical history, current condition, and support system and needs to determine appropriate discharge recommendations. Initiate, follow through and completion of collaborating with physicians, caregivers, patient, family, ancillary team members, outside agencies and payor to proactively develop and implement safe and appropriate discharge. Sending prior authorization and referrals to specialty physicians, SNF, rehab facilities, home health/hospice and behavioral health. Assist in maintaining current resources available for in patient, out patient and community resources. Educate patients and family about post discharge care and available resources. Advocate for patients needs and preferences during the discharge planning process, addressing any barriers or concerns that may impact a successful transition from the healthcare facility to the community. Collaborate with payor source and other funding sources to ensure coverage for necessary post-discharge services and resources. Maintain accurate and up to date documentation of all patient and family interactions, discharge plan, patients progress, and communication with outside agencies. Provide emotional support and counseling/resources to patients and families during the discharge process. Stay updated on healthcare regulations, policies, and resources to provide accurate and relevant information to patients and families. Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, readiness for discharge and patient status level. Liaison with insurance companies regarding status, coverage and approvals or denials. Collaborating with nursing, physicians, admission, fiscal, legal, compliance, coding, admitting and billing staff. Examine the medical record, treatment and interventions to assist in avoiding payment denials and optimizing reimbursement by assessing the treatment’s appropriate effectiveness, timing and setting based on regulatory and reimbursement requirements of various commercial and government payers

Requirements

Associates degree in Nursing
Idaho RN license or compact state

Nice To Haves

2-3 years acute care experience or direct patient/family care
Discharge Planning experience
Utilization Review experience

Responsibilities

Promote the mission, vision, and values of the organization along with the Gritman Way.
Conduct comprehensive evaluations of patient’s medical history, current condition, and support system and needs to determine appropriate discharge recommendations.
Initiate, follow through and completion of collaborating with physicians, caregivers, patient, family, ancillary team members, outside agencies and payor to proactively develop and implement safe and appropriate discharge.
Sending prior authorization and referrals to specialty physicians, SNF, rehab facilities, home health/hospice and behavioral health.
Assist in maintaining current resources available for in patient, out patient and community resources.
Educate patients and family about post discharge care and available resources.
Advocate for patients needs and preferences during the discharge planning process, addressing any barriers or concerns that may impact a successful transition from the healthcare facility to the community.
Collaborate with payor source and other funding sources to ensure coverage for necessary post-discharge services and resources.
Maintain accurate and up to date documentation of all patient and family interactions, discharge plan, patients progress, and communication with outside agencies.
Provide emotional support and counseling/resources to patients and families during the discharge process.
Stay updated on healthcare regulations, policies, and resources to provide accurate and relevant information to patients and families.
Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, readiness for discharge and patient status level.
Liaison with insurance companies regarding status, coverage and approvals or denials.
Collaborating with nursing, physicians, admission, fiscal, legal, compliance, coding, admitting and billing staff.
Examine the medical record, treatment and interventions to assist in avoiding payment denials and optimizing reimbursement by assessing the treatment’s appropriate effectiveness, timing and setting based on regulatory and reimbursement requirements of various commercial and government payers