RN-ACT

WVU Medicine

22h•Onsite

About The Position

This position coordinates utilization review activities to monitor and improve patient care standards and maintain quality care, adhering to professional policies, procedures, practices, regulatory requirements, and accrediting body standards. The role involves providing professional nursing care to clients within the ACT Program, directing and supervising ancillary personnel, and delivering a broad range of treatment and rehabilitation activities.

Requirements

Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
Obtain certification in Basic Life Support within 30 days of hire date.
State criminal background check and Federal (if applicable), as required for regulated areas.
Two (2) years clinical experience in mental health field.

Nice To Haves

One (1) year utilization review experience.

Responsibilities

Conducts initial clinical assessment of the patient at the time of admission to determine medical necessity using established admission criteria.
Performs concurrent and retrospective reviews with all third party payers consistent with their time frames and individual criteria.
Coordinates all aspects of the certification process to ensure that proper reimbursement is attainable. This includes pre-certifications, continued stay reviews, appeals, and any associated paperwork.
Facilitates ongoing education of house staff regarding proper documentation techniques.
Is the ACT Program’s advocate in a liaison relationship with third party payers and regulatory agencies.
Assures that all aspects of the medical record meet established hospital and accrediting agency standards.
Consistently protects the confidentiality of all clinical data relating to patients, physicians, and personnel.
Coordinates all quality assurance activities relevant to patient care, treatment planning and program evaluation.
Responsible for continued professional development in current utilization review standards and practices.
Collects and records data that is comprehensive, accurate and systematic, on the nursing and psychosocial assessment forms and in progress notes. Correlates all assembled data on the psychosocial assessment and history in a manner that is clinically pertinent to the individual patient.
Bases decisions made/actions taken on relevant scientific principles, established standards of care and/or research findings.
Utilizes nursing diagnoses and/or standards classification of mental disorders to express conclusions supported by recorded assessment data and current scientific premises.
Assesses and documents in the medical record the biopsychosocial needs of the patient, according to the developmental age of the patient.
Participates in treatment planning sessions by assisting in development of master treatment plan with specific goals and interventions delineating nursing and social work actions unique to each client’s needs and developmental age. Assists in determining appropriateness of admissions and receives referrals for social work intervention.
Intervenes as guided by the master treatment plan to implement nursing actions that promote, maintain or restore physical and mental health, present illness and effect rehabilitation.
Performs discharge planning as developed with the treatment team from day of admission. Acts as liaison for ACT Program patients and their families to various community agencies, hospital consultant and services.
Assists patients and families in achieving a satisfying and productive pattern of living through health teaching, and documents teaching according to hospital policy. Provides group therapy as deemed appropriate by the psychiatrist and Manager.
Establishes and maintains a therapeutic milieu in collaboration with the patient and other health care providers, taking developmental age of patient into account. This includes but is not limited to providing care to patients in a manner that considers safety, patient rights, and comfort. Setting limits in a therapeutic and consistent manner on a patient’s behavior within program guidelines and identification of verbal and non-verbal cues of potential aggressive behavior and application of de-escalation techniques to situations, are involved in maintenance of therapeutic milieu.
Determines the developmental age (level of development) on each patient and assists the treatment team in the development and implementation of a treatment plan specific with developmental needs and/or required intervention.