RN CASE MANAGER (28947)
UnityPoint Health - Rock Island, IL

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GENERAL DESCRIPTION:
Responsible for the coordination, integration and facilitation of all care and services for the patient by all the members of the health care team.

Performs admission assessment, screening for appropriateness, continued stay reviews according to established criteria of third party carriers, and as found necessary on cases with third party payor review. Monitoring of plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Responsible for reviewing and updating critical paths with healthcare team when applicable.

Also, assessing, monitoring, analyzing and documenting resources utilized in the provision of patient care.

Promotes communication and collaboration among all members of the health care team to ensure that specific patient outcomes are achieved and variances from accepted parameters are evaluated and addressed as needed.

Responsible for referral of cases to physician review, follow-up relating to professional review organization correspondence and generating reports and statistics relating to utilization review activities.

Qualifications/Experience

EDUCATION, TRAINING & EXPERIENCE: Registered Nurse with three to five years experience in an acute care, intermediate care or home care setting preferred with strong clinical background. Knowledge of utilization review, coding reimbursement, risk management and Quality Improvement principles.

Previous utilization review experience preferred. RN required. BSN or equivalent advanced degree preferred

KNOWLEDGE, ABILITIES & SKILLS: Must have knowledge of Medicare Regulations and familiarity with Professional Review Organization regulations.

Must have thorough knowledge of community resources and agencies, which may provide services to hospital patients.

Must have excellent communication skills both oral and written including the ability to communicate with physicians, hospital staff, patients, families and community agencies with the ability to negotiate and establish effective working relationships with members of the health care team. Must demonstrate ability to identify and act upon psychosocial needs and work independently in outcome oriented environment. Use of video display terminal required.

LICENSES, REGISTRATIONS AND CERTIFICATIONS: Must hold current licensure by the Illinois State Board of Nursing Examiners.
Job Information

RN CASE MANAGER

(28947)

Company:
TRINITY MEDICAL CENTER

Facility / Division:
TRINITY PHO

Account:
CASE MANAGEMENT

Department:
CASE MANAGEMENT

Employment Status:
FULL-TIME REGULAR (FTR)

FTE:
Full-Time (FTE: 1.00, Hours: 80)

Shift:
days

Location:
QC TRINITY WEST

2701 17TH ST

ROCK ISLAND, IL 61201

Primary Duties and Responsibilities

GENERAL DESCRIPTION:
Responsible for the coordination, integration and facilitation of all care and services for the patient by all the members of the health care team.

Performs admission assessment, screening for appropriateness, continued stay reviews according to established criteria of third party carriers, and as found necessary on cases with third party payor review. Monitoring of plan of care to address physical and psychosocial needs, and provide problem solving assistance. Coordinates services, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Responsible for reviewing and updating critical paths with healthcare team when applicable.

Also, assessing, monitoring, analyzing and documenting resources utilized in the provision of patient care.

Promotes communication and collaboration among all members of the health care team to ensure that specific patient outcomes are achieved and variances from accepted parameters are evaluated and addressed as needed.

Responsible for referral of cases to physician review, follow-up relating to professional review organization correspondence and generating reports and statistics relating to utilization review activities.

Qualifications/Experience

EDUCATION, TRAINING & EXPERIENCE: Registered Nurse with three to five years experience in an acute care, intermediate care or home care setting preferred with strong clinical background. Knowledge of utilization review, coding reimbursement, risk management and Quality Improvement principles.

Previous utilization review experience preferred. RN required. BSN or equivalent advanced degree preferred

KNOWLEDGE, ABILITIES & SKILLS: Must have knowledge of Medicare Regulations and familiarity with Professional Review Organization regulations.

Must have thorough knowledge of community resources and agencies, which may provide services to hospital patients.

Must have excellent communication skills both oral and written including the ability to communicate with physicians, hospital staff, patients, families and community agencies with the ability to negotiate and establish effective working relationships with members of the health care team. Must demonstrate ability to identify and act upon psychosocial needs and work independently in outcome oriented environment. Use of video display terminal required.

LICENSES, REGISTRATIONS AND CERTIFICATIONS: Must hold current licensure by the Illinois State Board of Nursing Examiners.

UnityPoint Health - 2 years ago - save job
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