Registered Nurse - Utilization Review

1000 Owensboro Health, Inc.; Owensboro (KY); On-site; USD 65,000 - 90,000; Full time

Job summary

Owensboro Health Regional Hospital is seeking a qualified Case Manager to facilitate cost-effective, quality patient outcomes and transitions by determining appropriate care levels and providing guidance and support to assigned patients.

The role entails collaborating with the care team, educating patients and families, and ensuring compliance with regulatory requirements. This position requires a nursing degree, active KY RN licensure, and the ability to work in a fast-paced environment.

Qualifications

• Bachelor’s degree in Nursing required upon hire.
• RN license and eligibility to practice in Kentucky required.

Responsibilities

• Assess chart and patient condition, finances, emotional needs and support systems.
• Review medical necessity and level of care using approved criteria within set timeframes.
• Provide clinical information to payers as requested within set timeframes.
• Collaborate with physicians and leadership on patients not meeting regulatory hospitalization requirements.
• Deliver regulatory letters to patients and educate about case management processes.
• Train new case managers, students and interns as needed.

Skills

Critical thinking

Decisive judgment

Stress management

Education

Bachelor’s degree in Nursing

RN license

Job description

Weekend Requirements: N/A | Work Hours: 1930 - 0330 | Status: Full Time - 1.0 FTE (80 hours per pay period) | Entity: Owensboro Health Regional Hospital | Department: Case Management

Job Summary

Facilitates cost-effective, quality patient outcomes and transitions by determining the appropriate level of care and providing guidance, education, and support to assigned patients.

Job Responsibilities

• Assessment of complete chart and knowledge of patient's medical condition, financial status, emotional needs, and support systems.
• Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame.
• Provides appropriate clinical information to payers as requested within specified time frame.
• Collaborates with the Attending Physician, Physician Advisor, Director, Manager, or Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization and delays in services and/or discharge.
• Delivers regulatory letters to patients as needed.
• Works in collaboration with the interdisciplinary team to ensure quality support of care and resource information.
• May assist patients/families with referrals to community agencies, post-acute providers, and/or provide education and resources.
• Provides education and acts as a resource for physicians, staff, and patients/families regarding case management processes.
• Trains new case managers, students, and interns as needed.

Skills and Attributes

• Requires critical thinking skills and decisive judgment.
• Works under minimal supervision.
• Must be able to work in a stressful environment and take appropriate action.

Position Requirements

• Work Experience No experience required.
• Education Bachelor’s degree or higher in Nursing required upon hire.
• Licensure/Certification/Registration RN - Licensed as a Registered Nurse.
• Eligible to practice nursing in the State of Kentucky required upon hire.

Organizational Responsibilities

• Supports Owensboro Health’s Mission, Vision, Core Commitments, and business interests.
• Adheres to all organizational policies and procedures.
• Executes all tasks and behaves in a manner consistent with a culture of compliance, safety and a high reliability organization.

Additional Job Information

This job description describes the general nature and level of work required by the position. It is not intended to be an all-inclusive list of qualifications, skills, duties, responsibilities or working conditions of the job. Specific duties and responsibilities consistent with the general nature and level of work described may vary by department and additional related duties may be assigned as needed. Some duties listed may not apply to all employees with this job description. The job description is subject to change with or without notice, and Management reserves the right to add, modify or remove any qualification or duty. Nothing in this job description changes the existing at-will employment relationship between the Organization and the employee occupying the position.

Standard ADA Settings

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Physical Demands

Standing: 75% Walking: 75% Sitting: 50 Lifting 0-25 lbs: 75% Lifting 25-75 lbs: 25% Lifting over 75 lbs: 25% Carrying 0-25 lbs: 75% Carrying 2575 lbs: 25% Carrying over 75 lbs: 25% Pushing/Plling 0-25 lbs: 75% Pushing/Pulling 25-75 lbs: 75% Pushing/Pulling over 75 lbs: 75% Climbing: 50% Bending/Stooping: 75% Kneeling: 50% Crouching/Crawling: 50% Reaching: 75% Talking: 75% Hearing: 75% Repetitive Foot/Leg Movements: 25% Repetitive Hand/Arm Movements: 75% Keyboard Data Entry: 75% Running: 50% Vision: Depth Perception: 75% Vision: Distinguish Color: 75% Vision: Seeing Far: 75% Vision: Seeing Near: 75% Hazardous Drug Risk Exposure: Risk Level: Low-Risk

Owensboro Health Core Commitments

• INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers.
• RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community.
• TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future.
• INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health.
• SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do.
• EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.

Owensboro Health is a nonprofit health system with a mission to heal the sick and to improve the health of the communities we serve in Kentucky and Indiana. The system includes Owensboro Health Regional Hospital, nationally recognized for design, architecture and engineering; Owensboro Health Muhlenberg Community Hospital; Owensboro Health Twin Lakes Medical Center; the Owensboro Health Medical Group comprised of over 200 providers at more than 30 locations; three outpatient Healthplex facilities, a certified medical fitness facility, the Healthpark; a surgical weight loss center and program, and the Mitchell Memorial Cancer Center.