Responsible and accountable for facilitating the provision of quality and cost-effective care delivery for a designated patient population during an acute episode of care. Ensures optimal care management, patient outcomes and reimbursement based upon enactment of the nursing process.
- Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team. (50%)
- Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients. (15%)
- Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team. (20%)
- Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population. (5%)
- Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues. (5%)
- Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies. (5%)
- BS/BA Degree Required.
- Current license to practice professional nursing required.
- Current CPR certification required.
- Inpatient clinical nursing experience in an acute hospital setting with two (2) years experience in the population to which the individual is to be assigned required or 2 years relevant CM/UM experience in another healthcare setting.
- Requires interpersonal, analytic, and critical thinking skills for problem solving and decision making, broad and intimate knowledge of reimbursement and regulatory requirements, decisive judgment and the ability to work with minimal supervision.
- Must be able to work in a fast-paced environment requiring adaptability, flexibility and independence while demonstrating high professional standards, leadership, and team membership skills.
- Case Management certification preferred.
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