Hospital Level Care at Home Intake Nurse

About the position

The Nurse Case Manager utilizes clinical expertise and critical thinking skills to develop and implement a plan of care that provides cost effective, extraordinary care. This position works collaboratively with patients, patient families/significant others, healthcare providers, insurers, community resources, and other involved parties.

Responsibilities

• Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility.
• Completes documentation as required.
• Performs utilization review activities to provide patient appropriate, timely, and cost effective care.
• Coordinates care with patient, care providers, hospital financial services, and third-party payers.
• Maintains an active role in denial prevention.
• Proactively intervenes with payers to prevent inpatient denials.
• Performs retroactive reviews on discharged patients as assigned.
• Communicates any necessary information to payers to help appeal existing denials.
• Uses level of care criteria to justify the patient's severity of illness and intensity of service.
• Reviews payer requirements and government regulations to ensure safe and cost-effective healthcare.
• Screens and coordinates the discharge planning process from patient admission to departure.
• Assesses patient needs, develops a discharge plan, and coordinates with internal and external services for care during and after the hospital stay.
• Identifies patients with potential avoidable delays, extended stay, readmission, or discharge needs.
• Coordinates with care providers and leaders to reach optimal solutions.
• Educates, communicates, and coordinates with multiple patient care teams to ensure the patient receives quality care, a timely discharge, and to identify and resolve delays and issues.

Requirements

• Current RN license for state in which the nurse practices.
• Three years of clinical nursing experience.
• RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion.

Nice-to-haves

• Bachelor's degree in Nursing (BSN).
• Case management Certification.
• Experience in Case management, Utilization review, and/or discharge planning.

Benefits

• Comprehensive benefits package that covers a wide range of programs to foster a sustainable culture of wellness.