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Utilization Review Case Manager | Case Management
3 months ago
Clinical/Technical: Recognizes, interprets, documents, and communicates information necessary for quality patient care and related patient information. Always maintains confidentiality to protect patient's privacy and maintains Health Insurance Portability and Accountability Act (HIPAA) privacy and security regulations. Carries out the hospital utilization review plan. Participates in daily interdisciplinary rounds. Asks clarifying questions regarding documentation, hospital course, and expected date of discharge. Provides clinical information to the payer as requested to obtain admission authorization and to support level of care. Communicates payer resources available for discharge planning to Case Management Team. Understands in-network coverage and out of network insurance coverage and impact on patients served. Communicates information to patient upon request. Coordinates with Patient Financial Services on all patients, including those without insurance coverage to obtain Hospital Care Assurance Program (HCAP) and Medicaid eligibility.
Interpersonal:Communicates in order to educate patients/family; provides kindness and consideration in meeting the emotional needs of patients; confers with Providers and Case Management Team, interacts with ancillary staff. Provides excellent customer service, facilitates quality care delivery and fosters an atmosphere of understanding cultural diversity. Communicates and assists providers as indicated. Must have excellent written, verbal and telephone communication skills. All interactions are conducted in a professional manner. Demonstrates a positive attitude. Resolves conflict through one-on-one negotiation or with the assistance of Director or designee. Demonstrates the philosophy of team concept. Participates in unit projects, attends committees as assigned, and attends monthly staff meetings. Communicates dissatisfaction with issues to Director; actively contributes to the solution of problems and refrains from promoting dissatisfaction among co-workers.
Critical Thinking: Actively looks for and creates opportunities to improve the department, staff, and personal development. Develops and demonstrates knowledge of current developments in field to maintain professional competency. Compliant with CMS, DNV, Federal, State, hospital and departmental policies and procedures. Follows the Ohio Nurse Practice Act. Understand the importance of Utilization Review and how job functions, impacts the revenue cycle, compliance, patient finances, and patient satisfaction.
Documentation: Maintains accurate data collection and timely documentation. Documentation retention practices are followed per hospital and department policy. Refrains from using unaccepted abbreviation in written documentation. When necessary, follows department downtime procedures. Maintains accurate employee records (ie attendance, record, education record, certifications, licensures etc.) Enters and retrieves information from computer; demonstrated competence in the electronic medical record, Microsoft/Outlook/Word/Excel, other software tools and portals as assigned.
Unit Financial Accountability: Understands and is accountable to hospital goals and benchmarks for financial viability. Is accountable for productivity and time management. Maintains appropriateness of supplies
Requirements
Completion of an accredited school of nursing with current active registration in the State of Ohio as an RN in good standing. Must have at least two years of clinical nursing or case management experience at an acute care hospital. Registered Nursing degree licensed in the State of Ohio; completes the required 24 contact hours of approved CE during each two year renewal period consistent with the Ohio Board of Nursing requirements. Maintains continuous certification in American Heart Association's BLS.
Shift
2nd w/every third weekend
(10:30 a.m. - 9:00 p.m.)
Hours
80 per pay (Every two weeks)
Benefits
- Medical Insurance
- Dental Insurance
- Vision Insurance
- Life Insurance
- Flexible Spending Account
Time Off
- Vacation
- Sick Leave
- 11 Paid Holidays
- Personal Day
Retirement
- Ohio Public Employee Retirement System
- Deferred Compensation
Other
- Tuition Reimbursement
- Kidzlink Daycare Center
- Employee Recognition
- Free Parking
- Wellness Center
- Competitive Salaries
- Community/Family Atmosphere
