Care Management RN

Responsible for assessing, planning, implementing and evaluating the needs of patients for discharge planning. Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing caring relationship with the patient. Responsible for assuring high quality, cost efficient medical outcomes. This includes those who may have Medicare, Medicaid, HMO or private insurance to cover their stay in various units. Utilization review procedures include those having the need for inpatient and or outpatient precertification/ preauthorization. Knowledge of criteria for Medicare, Medicaid coverage and that of HMO or private insurers.

• Responsible for performing assessments on high-risk patients to determine discharge planning needs.
• Establish effective rapport with other employees, professional support service staff, patients, families and physicians.
• Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
• Documents discharge planning in an ongoing manner.
• Responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.
• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.
• Identify appropriate alternative and non-traditional resources and demonstrate creativity in managing each case to fully utilize all available resources.
• Actively participates in Utilization Review Committee, QI, varying team meetings and other meetings as appropriate.
• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.
• Review for precertification/preauthorization requests for medical necessity. Able to provide insurance companies with proper clinical information.
• Review patient charts for medical necessity, reviewing clinical information for concurrent review, extending the Length of stay for inpatients as appropriate.
• Other duties as assigned.

Education/Experience:

• Graduate of an accredited school of nursing. BSN preferred.
• Current Registered Nurse licensure in the state of Nebraska.
• Current BLS Certification.
• 2 years of acute care experience preferred.
• 1 year of case management/utilization review preferred.