Registered Nurse (RN) Case Management (FT M-F 8-5)

UMC Health System

5d•Onsite

About The Position

We’ve learned that what is best for patients is also best for employees. Learn more about why we are one of the Best Companies to Work for in Texas®. Coordinates and manages the care of complex patients to facilitate achievement of quality patient outcomes. Performs utilization functions for appropriateness of admissions and continued hospital stay. Communicates with third-party payors, as needed, to assure reimbursement. Communicates appropriately with other care givers as needed. JOB SPECIFIC RESPONSIBILITIES: • Screen admissions each day to identify appropriate level of management required for each patient for the service area covered. Review new admissions, applying medical necessity criteria, and develop an anticipated discharge date for the assigned units/rooms. • Prepares to discuss patients with length of stay greater than 20 days and difficult discharges with the Managed Care Committee members on Wednesdays. • Assist and facilitate coordination of comprehensive, individualized plan of care in collaboration with interdisciplinary team. • Utilize CCM for documentation of Reviews, Appropriateness of admission and continued stay, Avoidable days, Denials, Interdisciplinary communication. • Monitor and facilitate appropriate utilization of resources. • Perform review functions for appropriateness of admission and continued hospital stay using Cerner Care Management (CCM)/InterQual criteria. Works with Emergency Room staff to facilitate transfer of patients needing lower levels of care to appropriate facilities. • Work with Emergency Room Staff to develop strategies to decrease Emergency Department use by individuals identified as "frequent users" and to find community resources for these patients. • Lead unit huddles (per unit guidelines) with Social Services to discuss discharge needs/ barriers and anticipated discharge dates. • Collaborate with the interdisciplinary team to formulate a safe, efficient discharge plan based on the patient’s needs and payer requirements.

Requirements

Must have current license as a Registered Nurse in the State of Texas
Minimum of five (5) years clinical nursing experience preferred.
Current licensure from Texas State Board of Nurse Examiners.
Good negotiation and communication skills required for high-level discussions with providers, payers, patients/families, and all other team members.
Excellent and efficient typing skills a must with the ability to learn and navigate through multiple software systems, multiple times daily.
Time management, organizational, and prioritization skills a must.
Leadership skills needed for leading daily huddles and driving safe, efficient discharges.

Nice To Haves

Bachelor’s degree in Nursing preferred.

Responsibilities

Screen admissions each day to identify appropriate level of management required for each patient for the service area covered.
Review new admissions, applying medical necessity criteria, and develop an anticipated discharge date for the assigned units/rooms.
Prepares to discuss patients with length of stay greater than 20 days and difficult discharges with the Managed Care Committee members on Wednesdays.
Assist and facilitate coordination of comprehensive, individualized plan of care in collaboration with interdisciplinary team.
Utilize CCM for documentation of Reviews, Appropriateness of admission and continued stay, Avoidable days, Denials, Interdisciplinary communication.
Monitor and facilitate appropriate utilization of resources.
Perform review functions for appropriateness of admission and continued hospital stay using Cerner Care Management (CCM)/InterQual criteria.
Works with Emergency Room staff to facilitate transfer of patients needing lower levels of care to appropriate facilities.
Work with Emergency Room Staff to develop strategies to decrease Emergency Department use by individuals identified as "frequent users" and to find community resources for these patients.
Lead unit huddles (per unit guidelines) with Social Services to discuss discharge needs/ barriers and anticipated discharge dates.
Collaborate with the interdisciplinary team to formulate a safe, efficient discharge plan based on the patient’s needs and payer requirements.