Job Location: Gettysburg, Pennsylvania Job Type: PRN Department:
Care Management (GH) Facility:
Gettysburg Hospital Shift:
Days/Evenings Hours:
as needed
Job Details:
RN Diploma
To work as needed as a Care Management Nurse arranging discharge planning, utilization review and community referrals.
General Summary:
Under general supervision of the CM Nurse Supervisor, performs a variety of and applies utilization and case management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team model to address patients discharge needs. Provides leadership in the integration of utilization management principles throughout the hospital.
Duties and Responsibilities:
1. Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load. 2. Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem solving techniques as needed prevent over and/or under utilization. 3. Liaison between third payors and the treatment regarding the identified treatment plan in accordance with contractual guidelines or system policy. 4. Assist the patient care team with the identification and coordination of discharge planning and alternative treatment settings which will provide appropriate care, maintain quality of care and reduce cost. 5. Identifies conditions, which require case management across the continuum. Collaborates with the members of the patient care team to identify interdisciplinary needs. 6. Assists with the collection and analysis of utilization patterns and denies case. 7. Bring known or suspected problem of under-,over-,or inappropriate utilization of resources to the attention of the appropriate manger (s). The following are common expectations: 8. Prepares and maintains appropriate documentation as required. 9. Provides outstanding service to all customers; foster teamwork; and practices fiscal responsibility through improvement and innovation.
The following are nonessential job accountabilities for ADA:
10. Maintains established policies and procedures, objectives, quality assessment and safety standers. 11. Prepares and present utilization data analysis as required. 12. Develops and initiates educational programs regarding utilization management principles. 1 3. Attends meeting as required and performs others related duties as identified.
Minimum Experience:
2-3 years
Preferredf field of Expertise:
Utilization Management, Case Management, or Clinical Nursing Specialty
