Registered Nurse (RN) - Case Management Specialist - UH Care Management - University Hospital

USA Health is transforming medicine along the Gulf Coast to care for the unique needs of our community. We are changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms, offering patients convenient access to innovative treatments and advancements that improve health and overall well-being.

Responsibilities

• Communication responsibilities:
  • Communicates and uses appropriate customer relation skills with physicians, patients, families, and healthcare team in person, via email, telephone, or other communication applications.
  • Responds to overhead pages.
• Citizenship responsibilities:
  • Accepts and completes all duties positively and without conflict.
  • Cooperates, helps others, and improves the performance of the department.
  • Completes all mandatory department, educational, and hospital requirements.
  • Utilizes cost-effective practices in performing all aspects of the job.
  • Maintains orderliness and cleanliness of work areas, equipment, and supply areas.
  • Functions in a cooperative spirit inter- and intra-departmentally.
• Department responsibilities:
  • Performs initial assessments on assigned patients within designated timeframe.
  • Identifies patient's immediate needs and available resources.
  • Serves as patient advocate across healthcare continuum.
  • Collaborates with healthcare team to formulate an appropriate discharge plan based on patient's needs and available resources.
  • Facilitates discharge plan by initiating electronic orders for home health, DME, or other post-acute services.
  • Communicates with healthcare team members with utmost professionalism.
  • Participates in healthcare team rounds and conferences as assigned.
  • Reviews worklist and responds to consults per departmental guidelines.
  • Collaborates with healthcare team to identify estimated length of stay for patient's primary diagnosis.
  • Completes referral processes for post-acute placements and services per departmental guidelines.
  • Documents initial assessments and follow-up assessments in medical record per departmental guidelines.
  • Identifies and documents avoidable delays in the medical record for departmental tracking purposes.
  • Completes all departmental forms timely and appropriately.
  • Identifies patients at risk for readmission and provides appropriate measures to help prevent readmission.
  • Assists healthcare team in setting up outpatient tests and services for patients when appropriate.
  • Uses departmental software programs for transitional care purposes appropriately and efficiently.
  • Provides available community resources to patients and caregivers when needed.
  • Ensures patients have access to primary healthcare and specialty provider services when needed.
  • Ensures patients have available transportation services to be successful and compliant with discharge plan.
  • Ensures patients have access to prescribed medications at discharge.
  • Communicates with providers or representatives from post-acute agencies with utmost professionalism.
  • Assists Utilization Review nurse in the event a patient appeals a discharge.
  • Assists Utilization Review nurse in distribution of notice of non-coverage letter as appropriate.
  • Assists Utilization Review nurse to ensure appropriate CMS documentation is provided to patient (IM Notice, MOON, etc).
  • Utilizes Physician Advisor Services appropriately.
  • Assists in orientation of newly hired Care Management staff.
• Other duties and responsibilities:
  • Other duties as assigned or required.
  • Participates on committees as assigned.
  • Participates in performance improvement activities as identified and assigned.
  • Adheres to hospital policies including confidentiality.
  • Enhances professional growth and development through participation in education programs.
  • Requires minimal supervision to safely perform essential functions.
  • Utilizes proper body mechanics when moving equipment or supplies necessary to perform essential functions.

Requirements

• Graduation from an accredited school of nursing meeting the minimum standards set by the State of Alabama and 2 years of professional nursing experience.
• Previous utilization review experience (preferred).
• RN - Registered Nurse - State Licensure and/or Compact State Licensure in accordance with the Nurse Licensure Compact (NLC) for Alabama (required).
• Comparable combination of education and experience may substitute for the above requirements.

Benefits

Employees must be in a regular position, working 20 hours or more per week (.50 FTE or greater) to qualify for benefits.