Job Summary
Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and adherence to a designated Geometric Length of Stay (GLOS) for each patient.
COMPANY DESCRIPTION
Frye Regional Medical Center, located in the beautiful foothills of North Carolina is a 355-bed acute care hospital, 81-bed Behavioral Health facility and more than 70 primary and specialty care providers.
Essential Functions
1. Identifies and implements placement of services to facilitate successful patient outcomes and highlighting patients at high to moderate risk for readmission. Follows all core measures diagnosis for readmission.
2. Serves as the contact for patients, families, and community liaisons to ensure coordination of post-acute services. Run daily readmission reports.
3. Provides support and education to the patient and families by listening and responding to their questions/concerns about the discharge process and educating them about the options that are available for post discharge care. Begin the coaching relationship.
4. Assists with the referral process based on patient and family choice as well as the ability of the post discharge facility to meet the specific needs of the patient.
5. Promote effective utilization of healthcare resources for placement in the appropriate level of care post discharge by facilitating updates to patients discharge plan.
6. Work collaboratively with the interdisciplinary healthcare team, internal and external, to achieve optimal clinical outcomes by following patient for 30 days post discharge.
7. Collaborate with physicians, patients, and families in the after-care planning process to ensure all critical elements have been communicated and addressed.
8. Document all discharge planning activities in Cerner and review data to ensure accuracy with the goal of improving the clinical experience for referred patients and their physician. Manage resources appropriately (scales, med planners, medication vouchers).
9. Strives to improve the discharge process for patients and their physician by monitoring the hospital patient satisfaction and physician satisfaction scores
10. Monitor regulatory issues and requirements regarding denial of benefits and provide information to appropriate individual. Contact payer to assess benefit coverage and the need for prior authorization for post discharge care.
11. Communicate with the physician and facilitate/expedite the discharge when patient is ready for lower level of care.
12. Attendance Policy
13. Communication by attending readmission meetings and provide feedback
Benefits - Wide range of benefits options!
Why join our team?
Frye Regional Medical Center employs more than 1500 professional and clinical staff. Our medical center is a 355-bed acute care facility which offers a broad array of inpatient and outpatient care. Frye Regional Medical Center is dedicated to providing patients with a full range of services to meet the healthcare needs of our community. We believe our employees are our most valuable assets in accomplishing this goal and we have made great strides to ensure employee satisfaction. If you are passionate about changing lives, we are looking for you!
Qualifications:Certifications/ Licenses
Associates Degree in Nursing required
Bachelor's Degree in Nursing preferred.
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Licenses: Current RN license to practice in NC (NC licensure or multi-state (compact) license).
NIH Stroke Scale required.
Minimum Work Experience
1-3 years case management experience preferred.
Two years hospital based clinical experience. Experience in Case Management, Utilization Review and/or discharge planning, knowledge of Interqual and other payor criteria preferred. Must have excellent communication skills, demonstrate self-direction, and have the ability to work well in a team environment
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