RN Transfer - PRN - Varies - Patient Intake Care

RN Transfer - PRN
- Varies
- Patient Intake Care

DHR Health - US:

TX:

Edinburg
- Varies

Summary:

POSITION SUMMARY:

Coordinates all admissions including interfacility transfers, and screens for appropriateness of admissions – targeting specific admission criteria requirements and medical necessity for admission. Utilizes Interqual-screening criteria for all admissions and observation status patients. Obtains physicians orders prior to admission. Utilizes Interqual Criteria for screening transfers into the facility. Must possess a thorough knowledge of hospital 3rd party reimbursement rules and regulations.

Assists in the identification of appropriate utilization of resources across the continuum of care.

Works collaboratively with interdisciplinary staff internal and external to the organization, and participates in quality improvement and evaluation processes related to the management of patient care.

POSITION EDUCATION/

QUALIFICATIONS:

· Licensed Register Nurse is required.

· Current license/valid permit to practice in the State of Texas will be required of all certified individuals.

· Candidate must demonstrate proficiency in both the English and Spanish language.

JOB KNOWLEDGE/

EXPERIENCE:

· Knowledge in the areas of case management and utilization management, experience with Managed Care and utilization management as it relates to third-party payers preferred.

· Three to five years clinical experience is required, with experience in a Hospital or acute care setting being strongly preferred

· Experience in use of Inter Qual and or Milliman criteria and review processes highly desirable.

· Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review and discharge planning.

Responsibilities:

POSITION RESPONSIBILITES:

1. Assists in the development and implementation of the case management program.

· Collaborates with already existing programs and departments to ensure appropriate resource utilization by all patients being followed in a caseload.

· Works with nurse managers, other clinical departments, and division directors in program development.

· Establishes and/or attempts appropriate caregiver forums to provide program teaching/information and seeks program effectiveness feedback.

· Provides orientation and ongoing education specific to case management.

· Participates in extending case management approach.

· Acts as a consultant to all disciplines specific to case management program.

· Performs ongoing evaluation of case management program.

Meets Criteria :

· Participates in daily rounds, providing education to other team members

· Provides follow-up to system issues and reports individual practitioner variances appropriately to PA or Department Director.

· Participates in respective nursing unit meetings.

2. Directs, coordinates, and provides case management to patients in caseload.

· Assesses the patients within the caseload to identify needs, issues, resources, and care goals.

· Through proper reporting mechanisms, completes case management assessment, reviews admitting diagnoses/problem(s), determines plan to address client's needs, and optional/preferred level of care. Develops a discharge plan early on in admission.

· Implements and coordinates interventions that will lead to goals in plan.

· Monitors the effectiveness of the plan.

· Participates in case finding and preadmission evaluation screening to ensure reimbursement.

· Identifies potential transition planning problems in a timely manner to set up services required.

· Works with attending physician and care team members to move patient through the hospital system and set up appropriate services or referrals.

· Identifies need for new resources if gaps exist in service continuum and initiates creative care delivery options.

· Daily responsibilities:

· Reviews the medical records of all observation and inpatient admissions to determine the medical necessity for admission and continued stay, using pre-established criteria (Inter Qual or Milliman) with appropriate frequency and Obtain physician's orders if necessary.

· Continues review of all patients using criteria and determines need for continued hospitalization based…