Infection Prevention & Case Management/UR Nurse

Brief Description POSITION SUMMARY The Infection Prevention & Case Management/Utilization Review Nurse is responsible for planning, implementing, monitoring, and evaluating the health system's infection prevention and control program while simultaneously coordinating utilization review and case management activities to ensure regulatory compliance, patient safety, quality outcomes, appropriate resource utilization, and reimbursement integrity. This position serves as the designated Infection Preventionist in accordance with CMS Conditions of Participation and supports organizational compliance with CDC, NHSN, APIC, CMS, state health department, and accreditation requirements. The role also conducts admission reviews, concurrent reviews, observation reviews, swing bed skilled nursing reviews, and utilization management functions to ensure patients receive the appropriate level of care consistent with medical necessity criteria. Essential Functions Infection Prevention and Control Responsibilities Program Management Serves as the designated Infection Preventionist for the health system. Develops, implements, maintains, and evaluates a comprehensive infection prevention and control program. Ensures compliance with CMS Conditions of Participation, CDC guidelines, APIC standards, OSHA regulations, and state reporting requirements. Conducts annual infection risk assessments and develops organization-wide infection prevention goals and action plans. Participates in Quality Assessment and Performance Improvement (QAPI) activities related to infection prevention and patient safety. Collaborates with medical staff, nursing leadership, pharmacy, environmental services, laboratory, employee health, and administration regarding infection prevention initiatives. Provides support for antibiotic stewardship activities and monitoring. Surveillance and Disease Prevention Conducts ongoing surveillance for healthcare-associated infections (HAIs). Identifies trends, outbreaks, clusters, and opportunities for performance improvement. Monitors infection indicators including, but not limited to:CLABSICAUTISSIMRSAC. difficileMultidrug-resistant organismsRespiratory and communicable diseases Coordinates outbreak investigations and implements mitigation strategies. Serves as liaison to local and state public health departments. Ensures implementation of transmission-based precautions and isolation practices. Monitors hand hygiene compliance and infection prevention best practices. NHSN Data Collection and Reporting Maintains facility enrollment and participation in CDC's National Healthcare Safety Network (NHSN). Collects, validates, analyzes, and submits required NHSN data. Ensures accuracy and completeness of reportable HAI events using NHSN definitions and criteria. Oversees reporting requirements related to:HAI surveillance modulesAntimicrobial Use and Resistance (AUR) reportingHealthcare personnel vaccination reportingCMS quality program reporting requirementsOther NHSN reporting modules as applicable. Produces monthly, quarterly, and annual infection surveillance reports. Benchmarks organizational performance against national NHSN data. Presents findings to leadership, Quality Committee, Medical Staff, Infection Prevention Committee, and Board as required. Education and Competency Develops and delivers infection prevention education programs for employees, providers, volunteers, students, and contracted personnel. Provides orientation education regarding infection prevention practices. Assesses staff competency related to:Hand hygienePPE useIsolation precautionsSterile techniqueHigh-level disinfectionDevice-associated infection preventionSafe injection practices Conducts audits and competency validation activities. Provides patient and family education on infection prevention, communicable disease management, isolation precautions, antimicrobial stewardship, and discharge infection prevention practices, as appropriate. Case Management and Utilization Review Responsibilities Admission Reviews Performs admission reviews for observation, inpatient, and swing bed admissions. Reviews clinical documentation for medical necessity and level-of-care appropriateness. Applies approved utilization management criteria (i.e. MCG or organizationally approved criteria). Collaborates with providers to ensure appropriate patient status designation. Facilitates physician advisor referrals for utilization review when necessary. Concurrent Reviews Conducts ongoing concurrent review of hospitalized patients. Evaluates continued stay criteria for:Observation patientsAcute inpatient admissionsSwing bed/skilled nursing patients Monitors avoidable days and barriers to discharge. Coordinates with interdisciplinary teams to promote timely progression of care. Facilitates payer communications and authorization processes as required. Identifies and escalates cases requiring secondary physician review. Swing Bed/Skilled Nursing Services Review Reviews patients admitted to swing bed programs for skilled level-of-care qualification. Verifies ongoing medical necessity and compliance with Medicare swing bed requirements. Assesses rehabilitation progress and continued stay criteria. Collaborates with rehabilitation services, nursing, providers, and discharge planning teams to ensure appropriate transitions of care. Utilization Review Program Support Supports the hospital's CMS-required Utilization Review Plan. Maintains documentation supporting reviews of:AdmissionsLength of stayProfessional servicesMedical necessity Tracks denial trends and opportunities for clinical documentation improvement. Participates in performance improvement projects addressing utilization efficiency and resource stewardship. Position Qualifications Competency Statement(s) Commitment to Excellence - A single-minded dedication to provide the highest quality service in every situation that leads to continual organizational improvement Customer Service - The ability to meet the service needs of the customer while exceeding the expectations of the customer. Adaptability - Ability to adapt to change in the workplace. Change Management - Ability to encourage others to seek opportunities for different and innovative approaches to addressing problems and opportunities. Communication, Oral - Ability to communicate effectively with others using the spoken word. Consensus Building - Ability to bring about group solidarity to achieve a goal. Decision Making - Ability to make critical decisions while following company procedures. Leadership - Ability to influence others to perform their jobs effectively and to be responsible for making decisions. Training - Ability to develop a particular skill in others to bring them up to a predetermined standard of work performance. Motivation - Ability to inspire oneself and others to reach a goal and/or perform to the best of their ability. Problem Solving - Ability to find a solution for or to deal proactively with work-related problems. Resource Management (People & Equipment) - Ability to obtain and appropriate the proper usage of equipment, facilities, materials, as well as personnel. Goal Oriented - Ability to focus on a goal and obtain a pre-determined result. Self Motivated - Ability to be internally inspired to perform a task to the best of one’s ability using his or her own drive or initiative. Energetic - Ability to work at a sustained pace and produce quality work. Requirements SKILLS & ABILITIES Education Minimum: Associate's Degree (two year college or technical school) Required, Field of Study: Nursing Preferred: Bachelor's Degree (four year college or technical school) Preferred, Field of Study: Nursing Experience Minimum: 2 plus years of experience of clinical nursing experience. Preferred: Infection prevention experience preferred. Case management and/or utilization review experience preferred Computer Skills Electronic Health Record Microsoft Suite of products Data Collection Tools Certificates & Licenses Current State of Kansas RN license BLS Other Requirements Thorough knowledge of CMS Conditions of Participation. Knowledge of infection prevention and control principles. Knowledge of NHSN definitions, reporting requirements, and surveillance methodologies. Understanding of APIC infection prevention standards and best practices. Knowledge of Medicare, Medicaid, observation, inpatient, and swing bed requirements. Proficiency with utilization management criteria tools. Strong clinical assessment and critical thinking skills. Data analysis and report generation skills. Ability to provide effective education and competency validation. Strong communication, leadership, and interdisciplinary collaboration skills. Able to develop and maintain excellent working relationships with staff and providers Fosters leadership growth among staff Able to identify and mentor potential nursing leaders Excellent time management skills Excellent prioritization skills Support systemwide objectives and priorities; link departmental goals and operations to system wide goals Knowledgeable of Kansas Statute Nurse Practice Act and follows applicable statutes and regulations Positive/action oriented Summary Work Schedule: M-F 8 to 5p. (38 hrs/week)