Registered Nurse (RN)-Discharge Advocate, Neonatal Intensive Care Unit (NICU), FT, Days

Prisma Health•Richland, WA

1d•Onsite

About The Position

Inspire health. Serve with compassion. Be the difference. Job Summary Provides case management service for the Acute Rehab patients, including, but not limited to, utilization management to ensure efficient, cost-effective patient progression through the continuum of care and discharge to an appropriate level of care. In collaboration with physicians, leads the multidisciplinary team including clinical staff and payors to ensure efficient delivery of quality, cost-effective care. Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference. Documents reviews in electronic medical record per department policy. Collaborates with physicians and other members of the healthcare team to ensure effective documentation of patient acuity and plan of care. Maintains expert knowledge of medical necessity criteria. Responsible for assessment of patient and family clinical discharge needs for patients. Initiates referral discharge services as appropriate. Documents case management assessment and discharge plan in electronic medical record. In collaboration with physician, monitors response to plan of care and recommends alternatives to ensure improved outcomes. Intervenes with ancillary departments when timely service is needed for quality, cost-effective patient care. Ensures that patient goals are set with patient/family, negotiates healthcare resources and educates patient/family regarding options of care throughout the continuum, monitors patient's progress and intervenes as necessary to ensure delivery of quality, efficient, cost-effective services. Consults with interdisciplinary team, Physician Advisor and administrative leadership as necessary to resolve barriers regarding progression of care. Collaborates with Physicians throughout hospitalization, develops an effective working relationship, and provides expertise regarding payor and regulatory guidelines. Leads interdisciplinary rounds with the healthcare team to establish treatment milestones to prepare patient and family for discharge and/or transition to a lower level of care. Leads patient/family care conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs. Serves as a clinical and financial expert resource to Social Worker, Patient Access, Denial Management and staff nurses. Uses established clinical guidelines for initial/admission and continued stay reviews for patients to ensure medical necessity, appropriate level of care and timely implementation of plan of care in accordance with PHT Utilization Review Plan. Promotes effective and efficient utilization of clinical resources, ensuring quality, cost effective car. Provides timely clinical reviews to third party payors. Responds to requests for additional information within 24hrs or next business day. Enters payor authorization numbers and approved days in the electronic medical record. Documents denial information in electronic medical record and coordinates peer to peer appeals when available. Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary, includes, but not limited to , delivery of the Medicare Important Message Letter outlining the patient's rights at discharge. Performs other duties as assigned.

Requirements

Graduate of an accredited School of Nursing program and approved by the State Board of Nursing.
Two (2) years post-acute healthcare related experience.
Holds a current RN compact/multistate license recognized by the NCSBN Compact State or is licensed to practice as an RN in the state the team member is working.
A valid driver’s license; an acceptable motor vehicle record, as defined by the Acceptable Motor Vehicle Record (MVR) Chart; and proof of auto insurance.
Knowledge of body systems and expected clinical outcomes for patient disease process.
Current knowledge of changes in state and federal regulatory requirements related to provision of case management services.
Communication skills
Computer literacy skills
Knowledge of applicable state and federal regulations regarding Acute Rehabilitation Care operations

Nice To Haves

Bachelor's degree in Nursing preferred.

Responsibilities

Documents reviews in electronic medical record per department policy.
Collaborates with physicians and other members of the healthcare team to ensure effective documentation of patient acuity and plan of care.
Maintains expert knowledge of medical necessity criteria.
Responsible for assessment of patient and family clinical discharge needs for patients.
Initiates referral discharge services as appropriate.
Documents case management assessment and discharge plan in electronic medical record.
In collaboration with physician, monitors response to plan of care and recommends alternatives to ensure improved outcomes.
Intervenes with ancillary departments when timely service is needed for quality, cost-effective patient care.
Ensures that patient goals are set with patient/family, negotiates healthcare resources and educates patient/family regarding options of care throughout the continuum, monitors patient's progress and intervenes as necessary to ensure delivery of quality, efficient, cost-effective services.
Consults with interdisciplinary team, Physician Advisor and administrative leadership as necessary to resolve barriers regarding progression of care.
Collaborates with Physicians throughout hospitalization, develops an effective working relationship, and provides expertise regarding payor and regulatory guidelines.
Leads interdisciplinary rounds with the healthcare team to establish treatment milestones to prepare patient and family for discharge and/or transition to a lower level of care.
Leads patient/family care conferences to review treatment goals, optimize resource utilization, provide family education, and identify post-hospital needs.
Serves as a clinical and financial expert resource to Social Worker, Patient Access, Denial Management and staff nurses.
Uses established clinical guidelines for initial/admission and continued stay reviews for patients to ensure medical necessity, appropriate level of care and timely implementation of plan of care in accordance with PHT Utilization Review Plan.
Promotes effective and efficient utilization of clinical resources, ensuring quality, cost effective car.
Provides timely clinical reviews to third party payors.
Responds to requests for additional information within 24hrs or next business day.
Enters payor authorization numbers and approved days in the electronic medical record.
Documents denial information in electronic medical record and coordinates peer to peer appeals when available.
Serves as a resource for patients and families with regard to their rights and responsibilities, when payment of care is denied or when care is no longer medically necessary, includes, but not limited to , delivery of the Medicare Important Message Letter outlining the patient's rights at discharge.
Performs other duties as assigned.