Primary Duties and Responsibilities:
Responsible for working collaboratively with physician partners to optimize quality and efficiency of care for hospitalized members by carrying out daily utilization and quality review, monitoring for inefficiencies and opportunities to improve care, developing a safe discharge plan to include recommending alternative levels and sites of care when appropriate. The activities will include daily review of hospital care by chart review and discussion with attending physician, admission and concurrent review for inpatient admissions, meetings with patient and families to develop discharge planning, identification of patients for ambulatory case management, communication with case managers, home care reviewers, social workers, members and providers, quality improvement reviews, and education of the member/family, provider and hospital staff. Achieves desired utilization and quality outcomes and promotes high customer satisfaction to the population served.
Minimum Education and Experience Requirements:
Preferred Education and Experience:
- Unrestricted c urrent Registered Nurse (RN) licensure in the state of Georgia required or documentation to show intent to seek license
- B.S. in Nursing
- Demonstrated advanced communication and interpersonal skills with all levels of internal & external customers, including but not limited to medical staff, patients and families, clinical personnel, support and technical staff, outside agencies, and members of the community.
- Ability to collaborate effectively with multidisciplinary healthcare team
- Excellent time management skills with the ability to work successfully in a fast-paced environment. Must be self-directed, and have the ability to tolerate frequent interruptions and a demanding work load.
- At least two (2) years of experience in inpatient utilization review or hospital case management, discharge planning and quality improvement in a health care or managed care setting
- Three (3) years of clinical nursing experience in a hospital setting
- Functional knowledge of computers
- Experience with managed health care delivery including Medicare
- Five (5) years of professional practice experience in an acute care setting.
- Experience in a payer environment highly desirable
- Knowledge of funding, resources, services, clinical standards, and outcomes is preferred.
This position is part-time, weekends only.
We are proud to be an EEO/AA employer M/F/D/V. We maintain a drug-free workplace and perform pre-employment substance abuse testing.