Case Manager PRN

Conway Regional Health System; Conway (AR); On-site; USD 60,000 - 80,000; Full time

Job summary

Conway Regional Health System in Conway, Arkansas is seeking a dedicated Registered Nurse or Licensed Practical Nurse to provide discharge planning and utilization review services. This position requires a current active license in Arkansas, a high level of nursing education, and preferably at least one year of experience in case management/utilization review. Responsibilities include analyzing patient information and ensuring compliance with medical necessity reviews. The role is designated as a Safety Sensitive Position as per state regulations.

Qualifications

• Registered Nurse or Licensed Practical Nurse with a current active license in Arkansas.
• Proof of the highest level of nursing education achieved is required.
• At least one-year experience in case management/utilization review preferred.

Responsibilities

• Determine appropriate acuity levels and utilization through chart review.
• Organize workflow to complete assignments in a timely manner.
• Maintain medical records in compliance with policies.
• Analyze patient information for admission necessity.

Skills

Clinical knowledge

Data analysis

Workflow organization

Communication

Education

Current active nursing license in Arkansas

Highest level of nursing education

Job description

Overview

Provides discharge planning and utilization review services in compliance with patients discharge planning needs and the hospital’s utilization review program.

SAFETY SENSITIVE POSITION:

This position is a designated as “Safety Sensitive Position” under Act 593 of the State of Arkansas. An employee who is under the influence of Marijuana constitutes a threat to patients/customers which Conway Regional is responsible for in providing and supporting the deliveryhealth care related services.

Responsibilities

• Apply clinical knowledge to determine appropriate acuity levels and utilization through chart review.
• Effectively organizes workflow to consistently complete assignments in a timely manner.
• Demonstrates ability to access and effectively utilize primary sources of data.
• Obtains and maintains medical records in conformance with Medical Information policies.
• Communicates with co-workers in a manner that is conducive to positive and effective working relationships. Demonstrates respect, honesty and integrity when working with other service providers.
• Demonstrates compliance with all relevant hospital, state and federal requirements related to maintenance of confidentiality of persons, data and information systems.
• Takes advantage of opportunities made available through CRHS and other professional organizations for continued professional growth and development.
• Responsible for analysis of patient information for determination of necessity of admission or continuation of stay.
• Review for medical necessity of admission on the first working day after admission using approved review criteria.
• Reviews inpatient procedures to determine appropriate utilization and acuity level. Reviews potential for outpatient setting or swing bed utilization.
• Reviews all patients for medical necessity of continued stay, or before the next review date, using approved review criteria.
• Performs retroactive reviews, as necessary, and responds to the appropriate review agency or third party payor.

Qualifications

• Registered Nurse or Licensed Practical Nurse with current, active license to practice in Arkansas, required
• Proof of the highest level of nursing education achieved, required
• At least one-year experience in the area of case management/utilization review, preferred