Utilization Review Nurse Care Manager | Concord Hospital | Full Time

Summary

The Inpatient Nurse Care Manager in collaboration with the multidisciplinary team is responsible for assessing planning implementing and evaluating patients incorporating the clinical psychosocial and family factors specific to the care and disease management plan. Communicates and manages the transitions of care and assists patient and family to navigate the health care systems. Recognize and intervene to secure resources necessary for the care and safety of the patient and family across the continuum of care. The Inpatient Care Manager will recognize and intervene to secure resources necessary through collaboration with financial payers / insurers for the care and safety of the patient and family across the continuum of care.

Education

Associates in Nursing degree from an accredited nursing program. Bachelors degree in Nursing preferred.

Certification Registration & Licensure

Licensure required : Current NH RN License.

Experience

Acute Care Facility experience of 2 years in a clinical specialty or Care Management Discharge planning Quality Improvement and Utilization Review. Demonstrates effective interpersonal organizational and motivational skills. Demonstrates ability to function as a team player. Proficient in written and verbal communication.

Responsibilities

Provides assessment and evaluation of patient for clinical psychological and social factors that may contribute to their disease process and may require specific or complex continuing care needs and supportive services. Provides an initial review and concurrent reviews as required for each patient for clinical psychological and social factors that may contribute to the disease process for determination of appropriateness of status severity of illness and intensity of treatment. Review of admission history and document in EMR.

Interfaces with patient physicians nurses social workers other hospital departments community based facilities services and financial institutions as necessary to affect changes in the management of cases monitoring delivery of services and / or to secure the necessary resources. Provides information to third party payers with required documentation of medical necessity.

Provides support to the patient and families and provides evaluation and coordination with care planning and patient safety while arranging for transitional care and discharge planning needs. Through utilization review determines if patient is meeting criteria of evidence-based clinical guidelines for appropriate level of care. Identifies the need to execute the appropriate letter when medical necessity is not met and issue letters of patient liability regarding the hospital admission.

Bases care management and utilization review actions by applying principles of purposeful organized thinking to make sound clinical judgment / decisions.

Documents measurement and evaluation of financial clinical functional and satisfaction outcomes as patient progresses towards desired goals.

Evaluates and responds to the learning needs of clients clinicians and community regarding discharge planning and utilization review.

Manages the care and utilization review of simple to complex multi-system patients by using time and resources efficiently.

Provides leadership to members of the health care team relative to discharge and care planning.

Performs other duties as assigned.

Concord Hospital is an Equal Employment Opportunity employer. It is our policy to provide equal opportunity to all employees and applicants and to prohibit any discrimination because of race color religion sex sexual orientation gender gender identity national origin age marital status genetic information disability or protected veteran status.

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Physical and Work Requirements

The physical demands and characteristics of the work environment described here are representative of those that will be encountered by an employee to successfully perform the essential functions of this job.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The Dictionary of Occupational Titles Material Handling Classification is LIGHT. The employee must regularly lift carry or push / pull less than 10 pounds frequently lift carry or push / pull up to 10 pounds and occasionally lift carry or push / pull up to 20 pounds.

While performing the duties of this job the employee is regularly required to speak. The employee is frequently required to bend do fine motor do repetitive motion hear kneel reach sit squat stand and walk.

Specific vision abilities required by this job include color vision depth perception far vision near vision and peripheral vision.

The employee is occasionally exposed to airborne contaminants airborne pathogens bloodborne pathogens bodily fluids and electrical hazards - shock.

The noise level in the work environment is usually moderate.

Required Experience :

Manager

Key Skills

Abinitio,Administration And Accounting,Android,Bid Management,Inventory Management,Embedded C

Employment Type : Full-Time

Experience : years

Vacancy : 1