RN UTILIZATION REVIEW

Description

POSITION DESCRIPTION 

Job Title: Case Manager/Discharge Planner Supervised by: Inpatient Manager

Job Summary: Facilitates the admission, continued stay, and discharge of a patient in the rehab continuum of care. Coordinates the delivery of functional outcomes with the efficient use of resources. Acts as liaison between the provider and payer; assists the team in planning care that is patient focused with an eye on function in the discharge setting while at the same time managing the patient’s financial resources.

Demonstrates   Competency in the Following Areas:

Coordinate new admission activities.

Assists patient and family members   with orientation to his/her program.

Coordinates team activities and   patient care for assigned careload.

Facilitates appropriate   transdisciplinary rehabilitation care plans and ensures the plan is   purposeful and goal directed.

Coordinates team patient care   conference and family conferences.

Serves as the liaison with patient’s   significant others as it relates to the integration of the patient into the   rehab program, promotes participation of patient in plans and goals, and   communicates patient outcomes.

Ensures discharge summary, discharge   medication lists, and continued plan of care are sent at discharge to   insurers, primary care physicians, continuum of care services, etc.

Maintains ongoing contact with   insurer and outside case manager.

Assesses, plans, and coordinates   patient discharge needs for a safe and smooth transition from the hospital to   the community and home.

Serves as a rehab liaison to all   units in the hospital as well as to outside facilities which will refer rehab   patients to our unit.

Uses financial information available   to assist the patient and/or family members in making informed financial   decisions.

Performs follow-up phone calls to   discharged patients in order to assess patient’s transition and follow-up   services.

Maintains and respects   confidentiality of patient/physician/staff information.

Demonstrates an ability to be   flexible, organized and function under stressful situations.

Works at   maintaining a good rapport and a cooperative working relationship with   physicians, departments and staff.

Consults other departments as   appropriate to collaborate on patient care and performance improvement   activities.

Documentation meets current standards   and policies.

Professional Requirements:

Adheres   to dress code, appearance is neat and clean.

Completes   annual education requirements.

Maintains   regulatory requirements, including all federal, state, local regulations and   accrediting organization standards.

Maintains   patient confidentiality at all times.

Reports   to work on time and as scheduled, completes work within designated time.

Wears   identification while on duty, uses computerized punch time system correctly.

Completes   inservices and returns in a timely fashion.

Attends   annual review and department inservices, as scheduled.

Attends 12   staff meetings annually, or reads and returns all staff meeting minutes.

Represents   the organization in a positive and professional manner.

Ensures   compliance with policies and procedures regarding department operations,   fire safety, emergency management and infection prevention and control.

Actively   participates in performance improvement and continuous quality improvement   (CQI) activities.

Complies   with all organizational policies regarding ethical business practices.

Communicates   the mission, ethics and goals of the facility, as well as the focus statement   of the department.

Regulatory Requirements:

· Graduate of an accredited school of nursing.

· Current state Registered Nurse Licensure, within state of practice.

· One to two years experience preferred.

Language Skills:

· Able to communicate effectively in English, both verbally and in writing.

· Additional languages preferred.

Skills:

· Basic computer knowledge.

Physical Demands:

· Mobility, sight, hearing, verbal communication, changes in temperature, exposure to disagreeable elements, exposure to biological, mechanical, electrical, and chemical hazards. Frequent standing and walking. Lift up to 100 pounds. Carrying up to 40 pounds. Pushing/pulling up to 450 pounds.

· This position is a safety sensitive position pursuant to Amendment 98 to the Arkansas Constitution § 2(25). A safety sensitive position means any position in which a person performing the position while under the influence of marijuana may constitute a threat to health or safety. This position is therefore “safety sensitive” due to the fact it requires the following: performing life-threatening procedures; working with hazardous or flammable materials, controlled substances, food, or medicine; and a lapse of attention while working in this position could result in injury, illness, or death.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

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I have received, read and understand the Position Description above.

Name/Signature Date Signed