POSITION SUMMARY:

Responsible for transitioning patient care through the health care system which includes coordinating care with the payer organizations, physicians and providers. Monitors all admissions for the appropriateness of observation or inpatient level of care according to InterQual Criteria. Initiates proactive discharge planning by utilizing the nursing process and identifying patients with discharge planning needs and coordinating necessary services in the home or skilled nursing facility settings.

 

EDUCATION/CERTIFICATION

Currently licensed as a Registered Nurse in the state of Connecticut. BSN preferred

EXPERIENCE

Two to five years' work experience in an RN role in a medical/ surgical acute care setting. Additional experience in case management, home care, and utilization review/management is preferred.

COMPETENCIES

Requires good analytical, organizational and interpersonal skills as well as the ability to communicate effectively in English, both verbally and in writing. Basic proficiency in personal computers is required.

ESSENTIAL DUTIES and RESPONSIBILITIES:

Disclaimer: Job descriptions are not intended, nor should they be construed to be, exhaustive lists of all responsibilities, skills, efforts or working conditions associated with the job.  They are intended to be accurate reflections of the principal duties and responsibilities of this position.  These responsibilities and competencies listed below may change from time to time.

 

Job-Specific Competency

1.      Assures and facilitates appropriate and efficient utilization of hospital services utilizing InterQual criteria in determining whether the patient meets observation or inpatient level of care and takes appropriate action when variances are identified.

2.      Collaborates with the Physician Advisor to ensure appropriateness of care, cost-effectiveness and best patient outcomes.

3.      Provides clinical information to managed care companies in a timely manner to receive authorization for payment while preventing denials through pro-active interventions with payors, physicians and hospital staff.

4.      Performs high risk assessments utilizing high risk stratification tool and refers complex high risk patients to the complex care navigator.

5.      Demonstrates understanding of level of care criteria and reimbursement factors for home care, rehabilitation, residential treatment and long term care in development of discharge plans.

6.      Performs comprehensive assessments and re-assessments of the patient's condition and discharge planning needs including the psychosocial, physical, educational and cultural aspects.

7.      Collaborates with the interdisciplinary team during interdisciplinary daily rounds to develop and modify the care plan to meets the needs of the patient.