SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS: Utilization Review
- Performs utilization review to insure admissions meet severity of illness and intensity of service based on Interqual criteria.
- Completes continued stay reviews and submits to private payers to ensure patient continues to meet inpatient admission criteria.
- Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes.
- Provides age and culturally appropriate care.
- Orients and mentors new staff members.
- Reviews metrics reporting data and make corrections according to CMS and HCA guidelines
- Ensure Medicare Order Form on chart, documented and authenticated.
- Works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge.
- Performs continuous assessments and evaluations to ensure patient is progressing toward desired outcomes.
- Assesses and responds to patient/family needs by coordinating efforts of other team members.
- Identifies and resolves barriers that hinder effective patient care.
- Collaborates and consults with physicians on patient's progress and discharge planning needs.
- Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patient and family members for decision making and in meeting psycho-social needs of patient.
- Maintains knowledge of resources and facilities available to patients and family members.
- Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions.
- Follows Standard Precautions using personal protective equipment as required.
- Effectively targets patients with diagnoses that are at risk for extended length of stays, patients who lack resources for optimum follow up at discharge, and patients who have been hospitalized for an extended period of time, as determined by the facility.
- Performs assessment and reassessment of assigned patients to ensure goals are met and discharge plans in place
- Attend interdisciplinary team (IDT) rounds daily at bedside with physician-lead IDT
- Communicate length of stay (LOS) barriers to discharge plan and assist with daily goals during IDT rounds
- Documents findings and recommendations in MIDAS under the HCM Care Coordination Support Service activity line in the Comments screen
Customer service abilities with effective listening skills
Critical thinking skills, decisive judgment and the ability to work with minimal supervision, meeting firm deadlines
Assertive and persuasive communication skills, action oriented team player. EDUCATION:
Required: Graduate of an accredited school of Professional Nursing.
Preferred: Bachelors of Science in Nursing. LICENSURE:
Required: VA state licensure as RN or multi-state compact license with eligibility to work in VA.
Required: AHA BLS for Healthcare Providers.
Preferred: CCM. EXPERIENCE:
Required: Minimum of 5 years of clinical nursing experience.
Preferred: Knowledge of CMS guidelines and experience working with payer specific guidelines and contractual rules.
A little about us:
HCA is the nation’s leading private provider of healthcare services. Comprised of locally managed facilities which include 230,000 employees at over 160 hospitals, over 120 surgery centers and 100 urgent care facilities in 20 states and the United Kingdom