Summary
Responsible for utilization review and discharge planning of all acute clinical areas. Responsible for all insurance authorizations, clinical communication, and denial and appeals.
Tracking and reporting of data for other departments.
Qualifications
EDUCATION
Graduate of Registered Nurse Program
EXPERIENCE
2 years acute care RN experience
LICENSE
Registered Nurse
CERTIFICATION
BLS (AMERICAN HEART ASSN)
LI-RS1
Tenet complies with federal, state, and / or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date.
If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.
The individual’s responsibilities include the following activities :
a) accurate medical necessity screening and submission for Physician Advisor review,
b) care coordination,
c) transition planning assessment and reassessment,
d) implementation or oversight of implementation of the transition plan,
e) leading and facilitating multi-disciplinary patient care conferences,
f) managing concurrent disputes,
g) making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
I) communicating with patients and families about the plan of care,
j) collaborating with physicians, office staff and ancillary departments,
k) leading and facilitating Complex Case Review,
l) assuring patient education is completed to support post-acute needs ,
m) timely complete and concise documentation in Case Management system,
n) maintenance of accurate patient demographic and insurance information,
o) identification and documentation of potentially avoidable days,
p) identification and reporting over and underutilization,
q) and other duties as assigned.
Education :
Required : Graduate of an accredited school of nursing
Preferred : Academic degree in nursing (bachelor's or master's)
Experience :
Required : 2 years of acute hospital patient care experience
Preferred : Acute hospital case management experience
Certifications :
Required : RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy.
Active RN license for state(s) covered.
Preferred : Accredited Case Manager (ACM)
Physical Demands :
Lift / position up to 25 lbs. Push / pull up to 25 lbs. of force. Frequent sitting. Moderate standing, walking, reaching, stooping, and bending.
Manual dexterity, mobility, touch, auditory to perform all the related duties of the position.
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