Position Summary: Responsible for the coordination of services through the continuum of care that balances the delivery of quality patient care with the cost effective utilization of resources. Performs concurrent clinical review to determine appropriateness of admission and continued need for care delivery in the acute hospital setting. Supports collaboration and communication among the patient/family and entire health care team regarding the patient's plan of care and continued needs post-discharge and facilities those services required. Performs telephonic clinical reviews with claims insurance personnel to facilitate reimbursement for the delivery of patient care services. Identifies quality and/or risk issues and reports to the appropriate individual/department.
A. Licensure/Certification/Registration: Colorado State Licensure as a Registered Nurse; Current BLS certification; Case Management or CPHQ certification strongly preferred.
B. Education: Graduation from an accredited school of nursing, Bachelor's degree in nursing is preferred.
C. Experience: Skill in assessing planning and managing patient care delivery as acquired thorough a minimum of 2 years of clinical nursing experience in the acute care setting. Prior utilization/quality/discharge planning/and/or case management experience highly preferred.
a. Solid clinical knowledge base in medical/surgical nursing.
b. Ability to perform effectively in team situations.
c. Ability to assess information and apply critical thinking processes to determine course of action and relay this information to the interdisciplinary team.
d. Excellent human relations and oral/written communication skills.
e. Above average organizational/prioritization skills.