Utilization Review - RN Case Manager

At ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

Under the general supervision of the Case Management Director, acts as a patient advocate/ Case Manager to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost-effective patient outcomes. 

Essential Functions

• Knowledge of and works within the CMS Conditions of Participation for Discharge planning
• Timely assessment of patients identified with discharge planning needs
• Development and implementation of discharge plans for each patient targeting optimal cost and quality outcomes
• Re-evaluation for discharge needs upon change of condition of the patient or caregiver ability to care for the patient
• Maximizes care coordination efforts and collaborates with the healthcare team to promote efficient movement through the continuum of care 
• Identifies and mitigates delays in delivery of care
• Effective and appropriate communication with the healthcare team, patient, and family
• Timely, appropriate, and accurate documentation of the discharge plan, patient progress to plan, and communication with the healthcare team, patient, and family in the medical record
• Assists the Director of Case Management with collection of data for the UM Committee and other reports
• Escalates cases appropriately
• As required, collaborates with payers to ensure authorization for discharge plan needs
• Participates in Interdisciplinary Rounds
• Displays effective communication skills
• Assists the Director of Case Management with other job duties as requested
• Demonstrates knowledge of HIPAA guidelines and utilizes them in all aspects of communication
• To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.  

Education

• Associates Degree in Nursing required. Bachelors Degree in Nursing desirable. 

Licenses/Certifications

• The Registered Nurse must possess a license to practice in the state

Experience

• 5 or more years in the acute care setting. Experience in other related healthcare settings considered. 
• Previous case management experience desirable but not required.