Registered Nurse (RN) - Hospital Care Manager, FT, Days
Company: Prisma Health
Location: Greenville
Posted on: October 10, 2024
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Job Description:
Inspire health. Serve with compassion. Be the difference.Job
SummaryThe RN-Patient Progression Leader provides case management
services for hospital patients, including, but not limited to,
utilization management to ensure efficient, cost-effective patient
progression through the continuum of care and discharge to an
appropriate level of care. In collaboration with physicians, leads
the multidisciplinary team including clinical staff and payors to
ensure efficient delivery of quality, cost-effective
care.Accountabilities:Works collaboratively with Unit team,
RN-Clinical Care Coordinator, Social Worker and Revenue Cycle to
progress each patient's care towards discharge.Discharge
Planning/Care Coordination:1. Evaluates discharge needs upon
admission, ensuring each patient has a complete discharge plan.2.
Identifies and escalates barriers to discharge as identified.3.
Identifies potential discharges and delegates updates of Estimated
Day of Discharge time in Epic. -4. Documents avoidable delays in
Epic, daily.5. Identifies and escalates barriers to discharge as
identified.6. Verifies regular follow up appointments are
scheduled.7. Medication Vouchers.8. Verify transportation prior to
day of discharge.Utilization Management:1. Completes UM (Complete
concurrent/continuous stay reviews) to assure that all payor and
status requirements are aligned according to patient's clinical
progression and governmental regulation per CMS guidelines.2.
Reviews Physician admission order and validates status and level of
care matches order.3. Serves as a consultant and educator with
medical staff regarding status, placement, payor requirements, and
utilization of resources.4. Identifies opportunities to transition
testing to the outpatient setting and escalates as
appropriate.Professional Development:1.Maintains expert level
knowledge of body systems and expected clinical outcomes for
patient disease process.2.Maintains current knowledge of changes in
state and federal regulatory requirements related to the provision
of case management services in a tertiary acute care setting.
-3.Maintains case management knowledge to provide services in
accordance with standards of practice as established by department
and leadership.Responsible for discharge activities for non-complex
discharges, collaborates with Social Worker.Reviews LOS values and
working DRG daily; updates in EMR as needed; Ensures patient is
meeting TLOS.Proactively monitors patients in observation or
outpatient status by completing a medical necessity review in the
EMR and progresses accordingly; escalates outliers to leadership as
appropriate.Financial Performance:1. Promotes effective and
efficient utilization of clinical resources, ensuring quality, cost
effective care. - -2. Provides timely clinical reviews to third
party payors. Responds to requests for additional information
within 24 hrs or next business day. -3. Enters payor authorization
numbers and approved days in the electronic medical record. -4.
Documents denial information in EMR and coordinates peer-to-peer
appeals when available. - -5. Serves as a resource for patients and
families with regard to their rights and responsibilities, when
payment of care is denied or when care is no longer medically
necessary. Includes, but not limited to, delivery of the Medicare
Important Message Letter outlining the patient's rights at
discharge and Medicare Outpatient Observation Notice for patients
whose level of care is changed to observation. -6. Issues Medicare
adverse determination letters and/or Hospital Issued Notice of
Non-Coverage (HINN) when deemed appropriate.Identify/assess patient
for readmission risk, communicates to care team, and updates
Epic.Active participant in SNAP interdisciplinary huddles.
Keywords: Prisma Health, Charlotte , Registered Nurse (RN) - Hospital Care Manager, FT, Days, Executive , Greenville, North Carolina
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