Registered Nurse - Case Management Speci...
Location: , Alabama
Description: University of South Alabama is currently seeking to employ Registered Nurse - Case Management Speci... right now, this career will be dwelled in Alabama. Further informations about this career opportunity please give attention to these descriptions. The USA Children’s & Women’s Hospital is one of six freestanding hospitals in the United States dedicated specifically to the uniqu! e health care needs of children, women and infants. The USA Children’s & Women’s Hospital is managed by the USA HealthCare Management, LLC.
Essential Functions:
Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization's values; adheres to hospital policies including confidentiality; enhances professional growth and development through participation in education programs; requires minimal supervision to safely perform patient care/essential functions; utilizes proper body mechanics when moving equipment/supplies necessary to perform essential functions; performs Care Management functions independently, according to policy and third party payor requirements, including but not limited to the following: quality reviews, prior authorizations, initial/admission reviews, continued stay reviews, discharge reviews, retrospective reviews, appeals (as appropriate fo! r denials) and case management reviews for DRG payors; analyze! s medical record data to complete Care Management functions; ensures optimization of reimbursement from third party payors through appropriate implementation of Care Management functions; communicates with healthcare providers, as required, via telephone, in person, and email, to perform Care Management functions (e.g. discussion with physicians regarding plan of care, length of stay, and stay type); establishes and maintains professional relationship with third party payor representatives; utilizes computer and all applicable clinical information systems to compete Care Management functions; participates in interdisciplinary patient care meetings as assigned; participates in all Care Management audit activities as assigned; reports quality of care concerns discovered during Care Management functions to the Director; completes annual education on nationally recognized level of care criteria; facilitates timely patient throughput through discharge planning commensurate with ! the care needs of the patient; evaluates chart documentation for completeness relative to current ICD requirements and communicates deficiencies; demonstrates proficiency in Early periodic Screening Diagnosis and Treatment (EPSDT) by performing independently, according to regulatory requirements, the following functions as assigned: identification of patient eligibility, collections of data required to perform screening, performance of Inter-periodic Screening Components and Communication of screening findings to all related parties; communicates and uses appropriate customer relation skills with physicians, patients, families and healthcare team in person and via telephone; responds to overhead pages and digital pagers; maintains accurate and complete records by: documents reviews according to hospital policy, completes/documents forms/requests from third party payors and regulatory parties, documents variances, documents discharge plans and documents EPSDT functions; acce! pts and completes all duties positively and without conflict; cooperate! s, helps others and improves the performance of the unit. Completes all mandatory unit, educational and hospital requirements; utilizes cost effective practices in performing all aspects of the job; adheres to current Infection Control and Safety Standards; utilizes personal computer and Clinical Information System to access, input, and retrieve patient/insurance data; participates in Performance Improvement activities through quality measurement or participation of ICARE; accesses and accurately maintains electronic and paper medical records; regular and prompt attendance and the ability to work schedule as defined and overtime as required; r elated duties as required.
Minimum Requirements:
Bachelor’s degree in nursing from an accredited institution as approved and accepted by the University of South Alabama, two years professional nursing experience, and licensure with the state of Alabama as a registered nurse. MSN and Pediatrics experience is prefe! rred.
Working Days and Hours:
Primarily Monday - Friday with possible call
Primarily 8:00 a.m. - 4:30 p.m.
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If you were eligible to this career, please deliver us your resume, with salary requirements and a resume to University of South Alabama.
Interested on this career, just click on the Apply button, you will be redirected to the official website
This career will be opened on: Sat, 07 Sep 2013 06:06:34 GMT
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