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Registered Nurse Case Manager – PRN (as needed) – JOB# 1266
The RN Case Manager is responsible for utilization review and utilization management for patients requiring observation and inpatient care at EPH. These duties are carried out in conjunction with the Medical Social Worker.
Shift:
PRN(as needed), shifts and hours will vary. *The shift and hours listed above may be subject to temporary or permanent change at any time according to the needs required to provide excellent and full services to our customers during employment.
Position Requirements:
- Required: Associates Degree in Nursing
- Preferred: Bachelor’s Degree in Nursing
- Current Colorado RN license
- Required: 3-5 years Acute Care Nursing
- Required: 1-2 years Utilization Review and quality data collection and reporting
- American Heart Association BLS.
- Preferred: Certification in UM or UR, must have within 12 months of hire
Duties:
- Performs utilization review for all patients utilizing software and other utilization management tools.
- Collaborates with physicians and provides information and education pertinent to medical necessity, patient conditions and corresponding utilization criteria.
- Oversees medical necessity documentation, data collection, and analysis. This includes collaboration with providers to optimize documentation.
- Interacts and collaborates with third party payers to facilitate the provision of clinical patient information.
- Reviews admissions and provides consultative recommendations related to placement and admission criteria
- Coordinates the Swing Bed Program. Ensure all CMS and state regulations are met.
- Establishes effective working relationships with Estes Park Health (EPH) staff, referral agencies, and other facilities with whom EPH receives and transfers patients to coordinate resources and services.
- Collaborates with the RN Case Manager to ensure receiving agencies/facilities receive appropriate patient information to facilitate continuity of care.
- Participates in patient/family care conferences.
- Facilitates education to optimize patient’s discharge plan.
- Collaborates with the RN Case Manager to assess discharge planning needs of patients, taking into consideration their emotional, physical, mental and spiritual needs and involving the family if appropriate.
- Chair the Utilization Management Committee
- Perform in accordance with all local, state, and federal laws and regulatory agency standards
- All other duties as assigned.
Hiring Range:
$36.98-$55.47, plus an hourly PRN flat rate of $4.50.