REGISTERED NURSE-Discharge planning- Med/Surg

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

Pay range for this part time positions is $33.58-$50.38

Position-Specific Performance Expectations, Duties, And Responsibilities

• Tracks patient cases from admission to discharge. Ability to identify patients who are likely to suffer adverse health consequences upon discharge, needing coordination of support services, and follow-up care based on diagnosis and level of acuity.
• 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.
• Fully understands transitional care and how that service works with a Critical Access Hospital.
• Ability to advocate for patients and negotiate with physicians and ancillary staff for patients.
• Ability to advocate for patients with insurance companies and CMS for additional services.
• Expert at InterQual and/or Millimen clinical decision-support criteria.
• Ability to identify patients at risk for abuse, depression, falls, or other conditions. Follows the proper procedures for reporting.
• Gathers pertinent clinical information and applies and interprets criteria to ensure medical necessity, covered benefits, participating providers, and appropriate services.
• Advocates that the patient is placed in the appropriate level of care and program.
• Interfaces with program staff to facilitate a smooth transition at the time of transfer or discharge.
• Monitors patient charts and records to evaluate care concurrent with the patient's treatment.
• Reviews treatment plans and status of approvals from insurers.
• Facilitates and coordinates discharge planning and works towards the reduction of preventable hospital admissions, re-admissions, etc.
• Works closely with the Revenue Cycle Department to ensure the insurance precertification process is complete and to update the denial log statistics on an ongoing basis (at least weekly), and initiate appeals through telephone or written communication within 7 to 10 days of denial.
• Collects and compiles data as required and renders with applicable hospital policies as well as state and federal guidelines.
• Communicates with the clinical care team on any outstanding or concerning findings during utilization review, including, but not limited to: failure to meet medical necessity, inappropriate admission status, etc.
• Communicates with providers to obtain any medical record documentation necessary to perform utilization review.
• Documents any UR needs or notes into the Electronic Medical Record (EMR).
• Administers or participates in audits of programs to ensure agency compliance with utilization review regulations.
• Performs other duties as assigned.