Nurse Case Manager - Utilization Review

Who We Are

JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.

Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance

outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

Why JPS?

We're More Than a Hospital. We're 7,200 Of The Most Dedicated People You Could Ever Meet. Our Goal Is To Make Sure The People Of Our Community Get The Care They Need And Deserve. As Community Stewards, We Abide By Three Rules Of The Road

Own it. Everyone who wears the JPS badge contributes to our journey to excellence.

Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.

Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.

When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

For more information, visit www.jpshealthnet.org .

To view all job vacancies, visit www.jpshealthnet.org , www.jpshealthnet.org / careers , or www.teamacclaim.org .

Job Title

Nurse Case Manager - Utilization Review

Requisition Number

42052

Employment Type

Full Time

Division

CLINICAL INTEGRATION

Compensation Type

Hourly

Job Category

Nursing / LVN

Hours Worked

7 : 00a-7 : 30p (Sat,Sun, Mon)

Location :

John Peter Smith Hospital

Shift Worked

Day

Job Description

Description : The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.

Typical Duties

Provides an assessment for all observation status patients prior to observation placement. The patient is to be assessed throughout the shift to determine discharge readiness or the need to convert to an inpatient status by using the approved medical appropriateness criteria and all third-party payer regulatory requirement.

Performs initial status review and level of care placement on all patients in an inpatient status using approved medical appropriate criteria in addition to third-party payer regulatory requirements.

Conducts an initial clinical assessment on assigned patients as well as discharge planning assessment prior to admission, at the time of admission, or at discharge.

Meets directly with the patient, family, and / or representative to assess needs and develop an individualized discharge plan based on the patient’s medical diagnosis, treatment plan, financial resources, and psychosocial issues, etc.

Reassesses the discharge plan throughout the patient’s hospitalization with input from the healthcare team and patient, family, and / or representative and modifying as needed.

Collaborates with the multi-disciplinary care team to ensure all needed clinical information is provided to the appropriate entities for the assigned level of care and supports the concurrent appeal process for any reduction in level of care or denial as requested.

Maintains active communication with the patient, family, and / or representative, physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management; documents each component of the case management process and related activities.

Identifies appropriate services not related to admission and assists in arrangement of services on an outpatient basis.

Leads the Unit’s daily interdisciplinary rounds to ensure a comprehensive plan of care is developed, including identification of patient needs, assignment of tasks to resolve clinical issues, review of discharge barriers, and identification of discharge planning options.

Generates referrals to the Case Management Physician Advisor according to departmental policies.

Serves as an educational resource for physician, nursing staff and others concerning case management strategies essential in meeting the organization’s quality, utilization, financial and customer satisfaction objectives.

Performs other related job duties as assigned.

Qualifications

Required Education and Experience :

Bachelor’s Degree in Nursing from an accredited college or university.

3-5 years of clinical experience and / or case management, utilization review, and / or discharge planning experience in an acute care setting.

Required Licensure / Certification / Specialized Training :

RN licensure through the Texas State Board of Nurse Examiners.

Preferred Education and Experience :

Master’s Degree in Nursing from an accredited college or university.

Preferred Licensure / Certification :

ACM Certification.

Location Address : 1500 S. Main Street

Fort Worth, Texas, 76104

United States