Job Description Responsible for providing professional nursing for patients following established standards and practices. Assists physicians and staff with the daily coordination of patient care and patient access. Coordinates patient flow, schedules appointments, procedures, tests and referrals. Serves as preceptor for clinical staff. Responsibilities Clinical Practice and Care Management Responsible for appointment and referral scheduling, chart management, providing information and instructions to patients, and coordinating patient flow. Performs selected nursing duties, including documenting patient functional history, Communication and Collaboration Provides complex and basic nursing care measures to all age groups. Assists physician with patient care, clerical, environmental and organizational tasks. Observes, records and reports (to physician) patient's condition and reaction to drugs and/or treatments. Instructs patient/family regarding diagnostic procedures, medications, nutrition and health/wellness issues. Quality Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards. Utilizes all equipment, supplies, facilities, and resources in a prudent and efficient manner in order to ensure efficient departmental operations and the provision of high quality health care services. Professional Development Observes and adheres to quality standards established by the department. Participates in continuous quality improvement programs in order to foster the provision of quality health care services by the department and hospital and ensures that all services are provided with compassion, understanding, and respect for others. Performs other duties as assigned or requested. Qualifications Experience -One year professional nursing experience Education - Graduate of accredited school of nursing Training Special Skills - Proficient in the English language, verbal and written communication skills, computer skills Licensure -Current Louisiana State license as RN and BLS certification
Job Description The Case Manager directs the utilization review of patient charts, treatment plans, and discharge planning pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager 1 specializes in the review of information pertaining specifically to the assigned areas. Relies on education, experience, professional training and judgment to accomplish responsibilities. A wide degree of creativity and latitude is expected. Works under minimal supervision. Directs the utilization review of patient charts and treatment plans pertaining to the quality of care and treatment criteria for patients in a specific department. The Case Manager of Clinical Services specializes in the review of information pertaining specifically to the assigned area (i.e.: Case Management, Geriatrics, Mental & Behavioral Health, Home Health). Most, but not all, of the accountabilities below may apply to each specific area. Responsibilities Evaluation and Analysis: Contributes to cost effectiveness/efficiency and demonstrates awareness of benefit system and cost benefit analysis. Demonstrates the ability to maximize financial outcomes of assigned patient load using the continuum of care philosophy. Assists in the development, monitoring, and analysis of annual financial goals of targeted population. Understands the capabilities of outside referral sources such as home health, sub-acute care and skilled nursing facilities. Understands the different types of healthcare delivery systems and the requirements for prior approval by payor for admissions, procedures, and continued stay. Meets with treatment team to provide utilization review information, discusses issues pertaining to continued stay, discharge and aftercare plans, evaluates current financial resources, and discusses whether documentation reflects the need for continued stay and at what level of care is the most appropriate. Partnership and Collaboration Performs effective utilization review techniques to work with physicians, third party payors, and federal and local agencies to prevent denials of payment or days. Acts as a resource for unit personnel in the resolution of utilization/case management problems and expediently communicates identified problems to appropriate personnel in an effort to enhance departmental operating efficiency. Collaborates with all members of the health team to ensure reimbursement optimization, appropriate discharge planning, and cost-effective quality care. Plays a key role in the discharge planning process assessing patient's needs for referrals and/or alternate levels of care. Appropriately tracks and reports avoidable days. Demonstrates competence in coordination and service delivery. Understands methods for assessing an individual's level of physical/mental impairment. Assesses patient clinical information and in collaboration with the healthcare team, develops treatment/discharge plans. Quality Evaluates the quality of necessary medical services, utilizes criteria to determine medical necessity of admission and interacts with physicians to facilitate patient assignment to appropriate alternative of care. Provides appropriate and timely information to third party payors to facilitate financial outcomes and ensures patients are receiving appropriate level of care; includes coordinating denials/appeals. Demonstrates ability to access and utilize community resources. Is knowledgeable of the ADA and other federal legislation affecting individuals with disabilities. Knows how to establish a client support system. Observes and adheres to all departmental and hospital policies and procedures, and follows all safety, quality assurance, and infection control standards. Promotes the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations. Other Duties as Assigned Performs other duties as assigned or requested. Qualifications Graduate from an accredited school of nursing, RN.Minimum of two years' clinical experience required. Case management or Utilization management experience preferred. Employee must demonstrate ability to recognize patients' individual needs based on medical conditions, age (infants, pediatrics, adolescents, young adults, middle-aged and geriatric), limitations and planned procedures. Requires oral and written communication skills; professional affiliations.Current Mississippi RN license required.
Job Description At Our Lady of Lourdes we offer you much more than just a job in the healthcare industry. We offer career opportunities for people who have a calling to share their gifts and talents as part of our healing ministry. As a Catholic hospital, we are here to create a spirit of healing - and we invite you to join our team today if you would like to be part of that spirit. In addition to competitive salaries and generous benefits, we offer you something special - the chance to do God's work by helping to serve people in need throughout our community, every day. Job Summary: The Clinical Access Supervisor will be the preliminary step of the utilization management process and the access point for admissions. Ensures the coordination of patient care and resource utilization at the time of access to Lourdes. The Clinical Access Supervisor will have an understanding of CMS requirements and guidelines to facilitate appropriate admissions, as well as managed care contracts associated with Lourdes. Serves as a resource in the areas of direct admissions, emergency admissions, transfers from outside facilities, and elective surgery/procedure scheduling and functions as a liaison between admissions, surgery scheduling, physicians and Medical Management. The Clinical Access Supervisor also supervises and coordinates activities of departmental staff, participates in planning work of unit assignments and coordinates activities with other patient care units and related departments. Also Supports compliance with existing criteria and guidelines that ensure appropriate resource utilization. Responsibilities Clinical Access Review Determines medical necessity and level of care guidelines using Interqual criteria for any questionable admission. Has an understanding of specific criteria required for admission, concurrent stay and an understanding of level of care and criteria subsets within each level of care. Ensures the compliance of EMTALA/COBRA regulations as it applies to transfers from outside facilities. Quality Promotes the quality and efficiency of his/her own performance by remaining current with the latest trends in field of expertise through participation in job-relevant seminars and workshops, attendance at professional conferences, and affiliations with national and state professional organizations. Collaboration and Partnership Works closely with the acute Unit Supervisors. Utilizing information provided by the admitting physician, will notify the Unit Supervisors of any potentially difficult cases to ensure the coordination of discharge planning upon admission. Ensures the movement of patients through the continuum of care, enhance quality of care delivered, and control resource utilization. Acts as a liaison between the physicians and Medical Management at the time of access. Under the direction of a Physician Advisor, the Clinical Access Coordinator will query the admitting physician for more information to determine medical necessity of the admission or the level of care desired. At the time of a questionable admission, the Clinical Access Coordinator will have the knowledge to direct the physician to an alternate level of care including skilled care, nursing home or outpatient services. Leadership and Supervision Assists in the effective hiring and training process for department staff. Assigns and monitors staff work and work schedules according to department policy. Maintains appropriate data on employee attendance for payroll/ATM. Administers performance review process in a timely and effective manner. Timely and effectively addresses employee relations issues. Demonstrates ability to coach and mentor staff. Facilitates patient throughput in the admission/discharge/transfer process. Coordinates and communicates critical information related to risk issues, guest service issues or other need to know information with administration, risk management, medical management, medical staff, and patient advocates. Other Duties Performs other duties as assigned or requested. Consistently performs 12 organizational Service Standards focused on Values, Service and Quality. Qualifications Bachelor's Degree RN - Current/unrestricted RN license BLS (Basic Life Support) Certification
