RN Case Manager Discharge Planning & Utilization Review PT

Arkansas Heart Hospital•Little Rock, AR

13d

About The Position

The Case Manager Discharge Planner/Utilization Review provides focused discharge planning, initiated as early as possible after admission, to facilitate timely and appropriate discharges in collaboration with the patient, family, and clinical care team. They further utilize the nursing process for age and diagnosis of specific populations to assess, plan and evaluate the care of a designated case load of patients so that clinical and financial oues are achieved.

Requirements

Education: Graduate of an accredited program of nursing or social work required.
RN required, BSN preferred for nurses.
Licensure/Certification: Current state issued license required for any RN or state certification required for Social Worker. Nurse may have license from a state within Nursing Compact.
Experience: Minimum of two years of case management experience with 1 or more years in a hospital setting preferred.

Nice To Haves

BSN preferred for nurses.
Experience: Minimum of two years of case management experience with 1 or more years in a hospital setting preferred.

Responsibilities

Provides focused discharged planning, initiated as early as possible after admission, to facilitate timely and appropriate discharges.
Maintains current, accurate information regardingmunity resources to facilitate discharge planning.
Identifies patients withplex discharge planning needs arising from diagnoses, therapies or psychosocial or other relevant circumstances.
Documents discharge planning activities in the medical record.
Facilitates transfers to appropriate higher level of care facilities when services are not available based upon the facility's Scope of Care (e.g., pediatric or neonatal intensive care).
Includes alternative care facility placement, DME, family involvement andmunity resource referral in discharge planning activities.
Directs and delegates activities associated with executing the discharge plan to appropriate personnel
Communicates effectively with patients, families, physicians, staff and other customers.
Communicates clearly and accurately in both verbal and written form.
Consistently demonstrates tact, diplomacy, sensitivity and professionalism.
Exhibits appropriate telephone protocol.
Ads to proper channels ofmunication in a courteous and cooperative manner.
Acknowledges each patientplaint within the shift and takes appropriate action.
Greets patients and visitors promptly and makes them feel wee.
Utilizes correct procedure in regard to hospital information systems andmunication with ancillary departments.
Actively participates in inter-disciplinary health team conferences.
Identifies and corrects conditions that affect employee safety; upholds safety standards.
Maintains stable performance under pressure or opposition; handles stress in a manner that is acceptable to others and to theanization.
Makes customers and their needs a primary focus on one's actions; develops and sustains productive customer relationships.
Having achieved a satisfactory level of technical and professional knowledge in position related to areas, maintains current development and trends in area of expertise.
Clearly conveys information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
Maximizes positive financial oues for his/her designated case types.
Develops and demonstratesanizational skills and effective time management skills on a daily basis.
Compares and contrasts resource utilization before and after a planned change.
Identifies and implements changes/strategies to improve profitability of targeted case types.
Ensures optimization of reimbursement through assignment of proper coding for specific cases.
Monitors and analyzes variances from standard and individualized clinical paths.
Assesses efficiency and cost effectiveness of interdepartmental systems.
Identifies andmunicates problems/inefficiencies in interdepartmental operations to the Director, Case Management.
Assists the Director, Case Management in planning, implementing and evaluating strategies to correct/improve problems/inefficiencies.
Performs and/or delegates admission and continued stay review for all payers and levels of care; performs these responsibilities within 24 hours of admission and continued stay reviews not less than every three (3) days.
Utilizes consistent processes to assure that all patients are evaluated and monitored for appropriate resource consumption.
Applies utilization review criteria objectively for admissions, continued stay, level of care and discharge readiness, using Milliman Care Guidelines or other facility criteria guidelines.
Screens and coordinates admissions and transfers, including emergency and elective care, observation status, conversions from outpatient to inpatient care and out-of-area transfers.
Participates in the investigation and collaborates with the attending physician in case denials and appeal process.
Collaborates with the attending physician when the medical record documentation does not reflect admission or continued stay criteria and confers with Case Management Director and/or Medical Director for assistance when consensus cannot be reached with the attending physician.
Ensures facility processes for working with external reviewers is followed in a timely andplete manner.
Communicates external UR determinations to patient and/or family when applicable.
Participates in the Case Management/Utilization Review Committee formal processes.
Collects and aggregates utilization data for tracking and trending reports.
Coordinates and maintains data to address issues of over-utilization, under-utilization and admission necessity.
Attends CM/UR Committee meetings as assigned.
Actively collaborates with CM Medical Director to maximize appropriate and efficient care of patients.
Is knowledgeable of and supports the AHH Utilization Review Plan.
Assists with coordinating peer review, focused reviews or other studies as directed by the CM/UR Committee
Maintains current knowledge of national standards or practice, as well as Joint Commission standards, appropriate to medical and nursing specialty.
Identifies educational needs of individual or groups of clinical staff through daily contact; conducts informal education of staff, as appropriate;municates learning needs to the appropriate Director and/or Clinical Educator.
Identifies andmunicates clinical staff practice variances to the appropriate Director