Nurse Jobs

About The Position

Requirements

• Bachelor’s degree in Nursing; a nursing diploma or Associate degree in Nursing may be considered under the stated BSN Memorandum of Understanding conditions.
• Three years of acute care nursing experience.
• Current RN compact/multistate license recognized by the NCSBN Compact State, or an RN license to practice in the state where the team member works.

Nice To Haves

• One year of acute care case management experience preferred.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred.
• Knowledge of Medical Necessity Criteria preferred.

Responsibilities

• Partner with attending providers throughout hospitalization to promote effective and efficient use of clinical resources and quality, cost-effective care.
• Anticipate care needs and facilitate communication to improve care efficiency for patients and families.
• Identify social determinants of health that may increase the risk of negative outcomes; document findings for the interdisciplinary team and coordinate post-acute plans with ambulatory care management as appropriate.
• Facilitate patient access to resources and relevant services.
• Identify, resolve, and document system problems, delays, and obstacles that impede diagnostic or treatment progress; identify areas for performance improvement.
• Support value-based care and ensure the longitudinal plan is patient-focused and aligned with patient and caregiver goals.
• Assess patients’ and families’ psychosocial risk factors based on preliminary risk screening, including prior functioning, support systems, response to illness, and ability to cope.
• Maintain knowledge of body systems, expected clinical outcomes, regulatory requirements, and care management standards of practice.
• Ensure medical necessity, appropriate level of care, and timely implementation of the plan of care in accordance with the hospital Utilization Review Plan.
• Guide the team through compliance, regulatory, and insurance requirements and coordinate regularly with third-party payors.
• Inform and support patients and families regarding their rights and responsibilities, including when payment is denied or care is no longer medically necessary; deliver applicable CMS regulatory documents.
• Advocate for patient and family empowerment, independent healthcare decisions, and access to needed services.
• Perform other duties as assigned.