Care Management Nurse - PRN

Responsibilities

• Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load.
• Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization.
• Liaises between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy.
• Affords assistance to the patient care team with the identification and coordination of alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost.
• Identifies conditions which require care management across the continuum.
• Collaborates with the members of the patient care team to identify interdisciplinary needs.
• Makes arrangements for discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families and care team as needed.
• Affords assistance with the collection and analysis of utilization patterns and denied cases.
• Brought to attention of the appropriate manager(s) any known or suspected problems of under-, over-, or inappropriate utilization of resources.

Qualifications

• Minimum Education: Associate's degree
• Work Experience: 2 years recent acute care experience
• Required Utilization management, care management, or clinical nursing specialty
• Preferred: Previous experience in care management, discharge planning, previous nursing experience in ED, critical care, trauma, step down units, medical, surgical, geriatrics
• Licenses: Registered Nurse - Upon Hire Required, Basic Life Support - Upon Hire Required