Registered Nurse; RN - Case Manager - Transfer Center | PRN

Location: Avera McKennan Hospital

Worker Type: PRN

Work Shift: Day Shift (United States of America)

Pay Range: $31.00 - $46.25 (Actual pay rate dependent upon experience.)

Responsible for reviewing and analyzing information for medical necessity criteria for both internal and external transfers within the Avera system. Serves as a liaison for any communication between sending hospitals’ case managers and providers and the Avera Transfer Center RN and accepting physician. The Transfer Center Case Manager reviews patients for medical necessity, including both the level of care and the status, for any patient transferred into the hospital for acute care.

This role also utilizes the EMR and patient‑flow software to ensure that patients are placed in the right bed at the right time, and assists with level‑loading patients across the Avera system to ensure access to care for all Avera patients. The case manager facilitates the plan for an orderly transition of patients from the acute area setting to the next appropriate level of care, working closely with physicians and payors to assure proper use of fiscal resources and to assure ongoing continuity.

• Provides customer services in a manner consistent with principles of service excellence to achieve patient, family, and physician satisfaction; maintains collaborative relationships with providers, facilities, and community agencies.
• Verifies the appropriateness and necessity of admission to the acute hospital for all patients; coordinates and communicates with all inter‑disciplines to develop a follow‑up plan of care.
• Assists in meeting regulatory requirements for reimbursement from government and private payers; stays informed of services covered by managed care organizations and government payers.
• Reviews all inbound and outbound transfers from Avera McKennan and identifies cases for potential repatriation to ensure access to regional/tertiary level of care.
• Serves as system resource for Avera system Critical Access and PPS Hospitals for discharge and post‑acute care planning and patient transportation needs; completes PASSR forms for outbound transfers from Avera facilities as Swing Bed transfers.
• Supports compliance with the Utilization Review Process, maintaining ongoing communication with Utilization Review staff regarding patient status and coverage.
• Acts as a resource to patients, their families, and physicians throughout all phases of hospitalization to ensure continuity and coordination of care, coordinating interdisciplinary team meetings as needed.
• Coordinates discharges for acute‑to‑acute transfers, home infusion, durable medical equipment supplies, dialysis needs, and long‑term acute care facilities.
• Provides medical information (including updates) to facilities as requested during hospitalization and prior to discharge to ensure continuity of care.
• Monitors documentation of patient care to assure an evidence‑based plan of care is in place throughout hospitalization.

The individual must be able to work the hours specified and perform each essential job function satisfactorily, including having visual acuity adequate to perform position duties and the ability to communicate effectively with others. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

• Registered Nurse (RN) – Board of Nursing. An active license in the state of practice upon hire.

• 4‑6 years of related experience and/or training.

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promotion of Avera’s values of compassion, hospitality, and stewardship.
• Upholding Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintaining confidentiality.
• Working effectively in a team environment, coordinating workflow with other team members and ensuring a productive and efficient environment.
• Compliance with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA, where applicable.

Avera is an Equal Opportunity Employer – Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, veteran status, or any other category protected by law.

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action

Employer:

Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.