RN - Utilization Review Case Manage Nurse FT

Gibson Area Hospital & Health Services; Gibson City (IL); Hybrid; USD 75,000 - 95,000; Full time

Benefits offered by this job

Sign-on bonus

Hybrid work model

Job summary

Gibson Area Hospital & Health Services is seeking a Utilization Review/Case Management nurse in a full-time hybrid role (in person and remote considered). You will review admissions for severity of illness, ensure appropriate stay levels, and coordinate discharge planning with the medical staff and nursing units to promote safe transitions of care.

The role involves multidisciplinary collaboration, payer discussions, and ongoing quality improvement efforts to enhance patient outcomes.

Qualifications

• Review admissions for severity of illness and appropriateness of hospitalization
• Coordinate discharge planning with interdisciplinary team
• Communicate with patients/families and payers to facilitate transitions of care

Responsibilities

• Coordinate and facilitate patient progression throughout the continuum to achieve outcomes
• Monitors review on all patient admissions to determine appropriateness of hospitalization
• Develop individualized discharge plans in collaboration with the interdisciplinary team
• Discuss payer criteria and issues with clinical staff on a case-by-case basis
• Provide concurrent reviews to assess changes in diagnosis, symptoms, and barriers to care
• Facilitate safe transitions to home or extended care facilities

Job description

• SIGN-ON BONUS: $5,000 FOR A 2 YEAR COMMITMENT**

• SIGN-ON BONUS: $5,000 FOR A 2 YEAR COMMITMENT**

JOB TITLE: UTILIZATION REVIEW/CASE MANAGEMENT – Nurse

DEPARTMENT: CASE MANAGEMENT (QUALITY)

HOURS & SHIFT REQUIREMENTS: Full time position. Hybrid (combination of in person and remote considered)

General Summary

The Utilization Review/Case Management Nurse is directly responsible for review of patient admissions for severity of illness and intensity of service to ensure appropriate level of stay and effective discharge planning is provided. Working closely with the Medical Staff and Nursing units in this effort, effective and efficient utilization is accomplished. Additionally, working with multi-disciplinary teams ensures safe transitions of care.

GIBSON AREA HOSPITAL & HEALTH SERVICES MISSION STATEMENT

To provide personalized, professional healthcare services to the residents of the Communities we serve.

Principle Duties And Responsibilities

• Coordinate and facilitate patient progression throughout the continuum to achieve desired outcomes and organizational goals while promoting continuity of care, collaborative practice and appropriate utilization of resources.
• Monitors review on all patient admissions to determine the appropriateness of hospitalization.
• Collects and records necessary information of admission for review.
• Meet with identified patients/families to assess needs and develop an individualized discharge plan, collaborating and communicating with the interdisciplinary team in all phases of the discharge planning process.
• Conduct appropriate reviews and discusses payer criteria and issues on a case-by-case basis with clinical staff.
• Demonstrates working knowledge of contractual arrangements and fiscal accountability as it relates to appropriate application of Utilization Management program.
• Provides concurrent reviews of all admissions to determine change of diagnosis, symptoms, problems, patient condition, treatment scheduled, admission status, barriers to care, and facilitates safe transition to home or extended care facility.
• Communicates with variety agencies both governmental and private to facilitate safe transitions of care, provide justification of admission, and provide continued length of stay based on Severity of Illness/Intensity of Service criteria, IntraQual &/or MCG Criteria.
• Initiate and facilitate referral for home health, hospice, durable medical equipment & supplies, nursing home placement, and Swing Bed placement & provides accurate documentation.
• Maintains knowledge of current trends and developments by reading literature and attending appropriate seminars, inservices, or conferences.
• Facilitates discharge planning and interdisciplinary healthcare conferences to communicate potential discharge needs.
• Assists and is involved in the Gibson Area Hospital’s continuous quality improvement efforts designed to enhance patient outcomes, increase patient satisfaction, and improve the utilization to the Gibson Area Hospital’s human capital and physical resources.
• Maintains confidentiality of patient information and patient privacy.
• Other duties as assigned.