Employment Type:Full timeShift:

Description:Functions as Primary Nurse Reviewer for Observation services.
•\tMaintains a working relationship with onsite Physician Advisor
•\tEducates Observation Case Managers, including week-end staff regarding appropriate process of telephonic and submission of cases
Reviews hospital admissions to ensure appropriate admission status in accordance with Indicia/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.
•\tCommunicates with physicians regarding appropriate setting for patient care
•\tInitiates clinical review in Epic and notifies PAS to start the notification process if not already completed to obtain authorization for admission.
•\tFaxes appropriate clinical documentation to Managed Care Plans to ensure authorization for hospital stay.

Responsible for educating and communicating Physicians regarding appropriate

Observation and Inpatient admission criteria in accordance with Indicia/InterQual criteria, CMS, and Managed Care regulations.

Ensure Observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation, from the ED or as directed admit. This time will be identified by the time the order for Observation is written by the attending physician. Extended Recovery services begin after an ambulatory surgery patient arrives on the unit after the routine period ends

Applies Indicia/InterQual criteria to ensure that the patient meets Observation level of care and will ensure a timed written order clarifying Observation and the reason for placing the patient in Observation is in the Medical Record. Documents Indicia/InterQual reviews in Epic on all Observation/Extended Recovery patients.

Patients receiving Observation/Extended Recovery services will be reviewed at least daily to ensure the patient is continuing to meet Observation level of care. If the patient meets Inpatient criteria, the Nurse will obtain a physician order to change the patient’s status to inpatient. If the patient is meeting discharge criteria or is out of Observation time and not meeting Inpatient criteria, the attending physician will be contacted to secure orders for discharge.

Ensures that all Extended Recover patients have the appropriate authorization for surgery on file and the authorization matches the orders on record for Managed Care Patients. For all Medicare patients, ensures that the surgery on file matches the completed procedure.Ensures no CMS Inpatient only procedure is statused as Extended Recovery. Removes all observation/extended recovery hours for Managed Care patients changed to inpatient status.Assumes daily responsibility to check if the observation/extended care hours were removed from all appropriate patients from the prior dayEducates and counsels Observation Case Managers on cases that were missed

Functions as a preceptor for case managers in the Observation Case Manager role.

Orients and supervises each RN Case Manager performing Observation case reviews to apply appropriate use of Indicia/InterQual criteria and Medicare 2 midnight rule, process of converting patients to inpatient by communicating with the Physician or Physician Advisor, appropriate documentation in EPICAssumes daily scheduling of obs cases to the obs case managers and follows-up at the end of each day to status and follow through needing to be completed

Able to adapt and work in any role within the department including but not limited to Utilization Review Case Manager, Observation or Department Coordinator, based on the needs of the department.

Assumes responsibility for work queues as assigned to the Department.

Demonstrates good operational management and facilitation skills.

Participates in developing protocols and policies to incorporate compliance and qualityCompletes PI monthlyDrives for cost effective process.Challenges the status quo and leads change.

Other duties as assigned.

Our Commitment to Diversity and Inclusion
 

Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.