Associates Degree Required
DUTIES: Assesses, plans, implements, monitors and evaluates options and services to effect an appropriate individualized plan of care for patients across the acute care continuum.
Performs required activities for utilization management, PRI assessment and completion, transition planning, and identification of actual or potential quality/risk indicators, in compliance with regulations and organizational goals. Performs as an integral part of the interdisciplinary team to effectively ensure optimal patient outcomes and length of stay efficiency. Considers payer requirements and responds accordingly to avoid adverse financial consequence to patient and hospital.
Works proactively with ED staff, ED charge nurse, and ED Physicians to identify potential admissions. Determines DRG-based initial LOS values for ED admissions (all status/types). Partners with ED nurse, ED Charge Nurse and ED Physician to communicate with patients about their admission and plan of care. QUALIFICATIONS: Graduate of an accredited school of nursing.
Current NYS RN license required, BSN Bachelor of Science in Nursing or Health preferred. Minimum of 3-5 years relevant clinical medical-surgical or specialty experience required as applicable to position needs. 2-3 years Utilization Management, Performance Improvement, Transition Planning and/or Care Management experience required in an acute hospital or related managed care setting. Required to pursue ongoing education, certification and self-development to remain current with industry standards and business objectives related to Care Management as appropriate.
SPECIAL REQUIREMENTS: Basic Knowledge of software for word processing and/or Hospital Information Systems preferred, or the ability to enter and retrieve data from relevant computer systems. Ability to effectively communicate with all levels of hospital staff in a verbal and written manner.
PRI certification. Knowledge of The Joint Commission/CARF (as appropriate) NCQA (as appropriate) standards, and Federal, State and PRO regulations preferred.
St. Catherine Of Siena