Registered Nurse (RN) - Case Manager - Transfer Center | PRN

Avera•Sioux Falls, SD

1d•$31 - $46•Onsite

About The Position

Responsible for reviewing and analyzing information for medical necessity criteria for both internal and external transfers within the Avera system. Serves as a liaison for any communication between sending hospitals' case managers and providers and Avera Transfer Center RN and accepting physician. The Transfer Center Case Manager reviews patients for medical necessity, including both the level of care and the status, for any patient transferred into the hospital for acute care. This role will also utilize the EMR and patient flow software to ensure that patients are placed in the right bed at the right time, as well as assist with level-loading patients across the Avera system to ensure access to care for all Avera patients. The case manager facilitates the plan for an orderly transition of patients from the acute area setting to the next appropriate level of care. Works closely with physicians and payors to assure proper use of fiscal resources. Serves as liaison with physicians and staff to assure on going continuity.

Requirements

The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
Registered Nurse (RN) - Board of Nursing
An active license in the state of practice
Upon Hire

Nice To Haves

4-6 years related experience and/or training

Responsibilities

Provides customer services in a manner consistent with principles of service excellence in order to achieve patient, family and physician satisfaction.
Maintains collaborative relationships with providers, facilities and community agencies.
Communicates in a respectful, courteous manner and assures that patients, families, and referral facilities receive thorough information.
Verifies the appropriateness and necessity of admission to the acute hospital for all patients.
Coordinates and communicates with all inter-disciplines to identify, plan for, and provide an appropriate follow up plan of care for all patients.
Communicates this plan of care to patients, families, physicians, other hospital staff, communities, other agencies, and departments as necessary.
Assists in meeting regulatory requirements for reimbursement from government and private payers.
Maintains knowledge of services that are covered by managed care organizations and the government payers.
Reviews all inbound and outbound transfers from Avera McKennan.
Reviews appropriate cases for potential repatriation in an effort to ensure access to regional/tertiary level of care.
Serves as system resource for Avera system Critical Access and PPS Hospitals for discharge and post-acute care planning and patient transportation needs.
Completes PASSR forms for outbound transfers from Avera facilities as Swing Bed transfers.
Supports compliance with Utilization Review Process.
Case Manager will have ongoing conversation with Utilization Review staff on patients status and ongoing coverage
Is a resource to patients, their families, and physicians as well as other disciplines, through all phases of hospitalization to ensure continuity and coordination of care.
Uses nursing judgment and coordinates interdisciplinary team meetings in an effort to ensure ongoing assessment and care planning needs are met.
Coordinates discharges for acute to acute transfers, home infusion, Durable Medical Equipment supplies, dialysis needs, and long term acute care facilities.
Provides medical information (including updates) to facilities as requested during hospitalization and prior to discharge from facility to ensure continuity of care.
Monitors documentation of patient care to assure appropriate evidence based plan of care in place throughout hospitalization.