Under the direction of the Case Management Manager and the Director of QRM, reviews admissions and extended stays of all PPS, non-PPS, managed care, self-pay and other third party payers in accordance with procedures set forth in the Hospital Utilization Management Plan and the criteria and standards approved by the medical staff.
In collaboration with the Director of Quality and Resource Management, maintains a data collection system for monitoring admissions and assigning extended stays in accordance with criteria approved by the Utilization Management Committee and Medical Staff with referral of all cases in question to the Utilization Management Physician Advisor.
Communicates with third party payers regarding extended stays for approval.
Coordinates Discharge Planning meetings with nursing and ancillary staff on individual nursing units to promote ongoing review of patient care activities related to provision of services, patterns of care, and utilization of resources.
Assists in Utilization Management Committee activities by providing data for reports, medical care evaluation studies, and maintenance of records as deemed appropriate.
Maintains liaison with Social Worker and other individuals/groups responsible for discharge planning to facilitate continuity of care which may include initiating and/or coordinating discharge planning.
Recognizes the purpose of employment is to prioritize the patient as number one.
Fulfills the duty and responsibility to maintain competence and to continue personal and professional growth.
Identifies and assists with opportunities for performance improvement activities on the unit and with other service areas.
Demonstrates fiscal responsibility by taking ownership of time management, decreasing waste (of time and supplies) and promoting cost effectiveness while maintaining patient safety and quality of care.
Demonstrates the ability to be an advocate for and strive to protect the health, safety and rights of the patient.
Interactions with patients and colleagues demonstrate compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status or cultural beliefs.
Communicate effectively with other care providers (physicians, nurses, and satellite staff) to provide for continuity of patient care and to meet the needs of the customers we serve.
Demonstrates ability to fulfill requirements of attendance, punctuality, and timekeeping practices.
Behaviors and interactions demonstrate a positive attitude, personal initiative and motivation to achieve the goals of the unit.
EDUCATION REQUIRED AND/OR PREFERRED:
Associates or BSN.
Current licensure in Texas as a Registered Nurse, Licensed Vocational Nurse or Registered Health Information Technician (RHIT).
EXPERIENCE REQUIRED OR PREFERRED:
Experience in health care delivery systems with focus on Quality and Resource Management preferred.
SKILLS, KNOWLEDGE, AND ABILITIES:
Basic computer skills. Knowledge of case management. Ability to communicate well with others both written and verbal.
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