Discharge & Care Transition Nurse Advocate

Memorial Regional Health; Craig (CO); On-site; USD 47,000 - 69,000; Part time

Job summary

Memorial Regional Health in Craig, CO seeks a part-time discharge planning and utilization review professional to coordinate patient care from admission through discharge. You will evaluate patients, develop individualized care plans, and advocate for resources while coordinating with physicians, nurses, and the Revenue Cycle team to ensure timely precertifications and reduce avoidable hospital stays.

Experience with clinical decision-support criteria (e.g., InterQual/Milliman) and EMR

Responsibilities

• Tracks patient cases from admission to discharge.
• Conducts timely evaluations for all patients identified by their physician, patient, nursing, family, or friend requests, or discharge planner inquiry as needing discharge planning.
• Ability to develop an individualized care plan for patients needing patient care planning support.
• Ability to use critical thinking skills supporting patients in accessing all necessary applicable resources for follow-up care.
• From admission (regardless of status) ensures that patients are "pre-qualified" for hospital admissions.
• Continued admission (regardless of status) ensures that patients are "re-qualified" for hospital admissions.
• Conducts appeals on behalf of the patient and family (at the time of service and for hospital stay denials).
• Develops discharge plans for patients to the most appropriate plans of care - understands the resources available and advocates for the patient for those resources.
• Understands Lifeline, Transition Care, Swing Bed, Home Health, Hospice, Nursing Home Services, and can discern and explain which resource may be best for a specific patient based on diagnosis and level of acuity.

Job description

Memorial Regional Health in Craig, CO seeks a part-time discharge planning and utilization review professional to coordinate patient care from admission through discharge. You will evaluate patients, develop individualized care plans, and advocate for resources while coordinating with physicians, nurses, and the Revenue Cycle team to ensure timely precertifications and reduce avoidable hospital stays.

Experience with clinical decision-support criteria (e.g., InterQual/Milliman) and EMR