Registered Nurse - Care Management/Utilization Review

Description

St. Croix Health is currently seeking full-time (0.8 FTE) Care Management/Utilization Review Registered Nurse to join our team. This position will work Monday through Friday, day hours and every third weekend.    

The RN Case Manager/Utilization Review is responsible for coordinating care and service of select patients, case management, utilization review, quality assurance, and for the promotion of collaborative practice and continuity of care.  

Essential Duties and Responsibilities:

1. Collaborates with health care team to ensure smooth care transitions.

• Participate in care conferences daily and set up family conferences as needed
• Work closely with Hospitalist to ensure appropriate communication between MD, RN, patient, and family occurs daily 
• Collaborate with patients’ families, friends and social support in developing treatment plan for discharge
• Link patients to social services programs
• Maintain and enhance relationships through the community and referral resources
• Comply with hospital policies and procedures

2. Provides Utilization Review to all hospitalized patients.

• Evaluate patient chart and documentation to ensure appropriate patient status
• Implement and maintain Interqual criteria and guidelines 
• Work with providers to ensure chart documentation supports patient class and provider orders and signatures are obtained as needed
• Communicate with third party payers as requested, obtain prior authorization as appropriate, and provides information as needed
• Conform to all requirements of Medicare
• Maintain compliance with State and Federal Guidelines and standards
• Evaluate financial assessment to determine patients’ source of payment for in-patient admission or observation stays to initiate review process and payment of services

3. Assists with quality projects.

• Assist/lead quality projects in the department 
• Assist with chart review and special projects in the department
• Compile monthly statistics for quality reports

4. Conducts case management of care through the hospital stays and post discharge. 

• Perform assessment of patient’s needs including interview with patient, family members/caregivers, chart review and collateral staff members
• Identify discharge needs of the patient and family, facilitating a smooth and safe transition of care
• Facilitate the transition home by ordering equipment and arranging and referring external services prior to discharge
• Refer patients that are no longer requiring acute care to other services i.e., swing bed, LTC, transitional care 
• Complete discharge phone calls 
• Solicit information from patients and families about satisfaction with care
• Initiate referrals as needed to enhance patient care
• Provide information to patients regarding advance care directives, assisting in completion of forms, and obtaining witnesses signatures
• Educate patients upon discharge and assist with nursing duties as assigned

Requirements

Education & Licensure:

• Associates Degree in nursing required, Bachelor's degree preferred
• Current WI Registered Nurse required

Certifications:

• BLS required at time of hire

Experience:

• 2 years minimum acute care experience
• Knowledge of Utilization management principles, transitional care, swing bed, home health care, skilled nursing facilities and long-term care and durable medical equipment is highly desireable. 

Knowledge, Skills & Abilities:

• Excellent written and verbal communication skills
• Good organizational abilities, attention to detail and ability to multi-task
• Skill in the use of personal computers and related software applications
• Ability to analyze and solve problems
• Ability to maintain confidentiality and privacy with patients and families
• Complete annual educational requirements

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.
• Prolonged periods of standing, bending, and reaching
• Must be able to lift up to 50 pounds at times. 

St. Croix Health is an Equal Opportunity Employer.

St. Croix Health has been a healing force in the St. Croix Valley for over 103 years. We are a purpose-driven organization with a dedicated team committed to serving our patients and communities throughout the St. Cro