About Trenton Hospital
This Magnet-designated facility provides comprehensive medical and surgical care for its patients and is one of four recipients of the Truven Health Advantage Award in the category of Health and Clinical Outcomes. It is home to nine university affiliated residency programs. Here, you will find a Level II trauma center that is a nationally recognized heart, vascular and pulmonary specialties along with other specialties like orthopedics, neurosurgery, and women's health.
Scope of work
Under general direction, integrates cost, quality and utilization to facilitate the admission, continued stay and discharge of the patient. Reviews and evaluates appropriateness of admission or continued stay based on medical necessity. The overall goal of the position is to enhance the quality of patient care and engagement, to promote continuity of care and cost effectiveness through the integration and functions of utilization management, and/or care coordination, discharge planning, and appropriate care transitions. Has accountability for the care coordination and discharge planning of all hospitalized patients.
Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning).
Responsible for managing a case load of patients that includes facilitating utilization management, and/or care coordination during the patient's stay, planning and expediting plans for safe and effective discharge and transition to the appropriate level of care and setting needed after hospitalization. Coordinating care by considering all patient's needs.
Uses critical thinking and effective judgment to determine alternative courses of care. Judiciously uses tools designed to expedite care while being cost effective. Actively participates in readmission initiatives and strategies to maximize patient flow and appropriate resource utilization. Works collaboratively on processes to provide effective transition for patients utilizing hospital outpatient, observation or inpatient services.
May review cases for medical necessity, uses InterQual and/or other UR/UM Committee-approved medical necessity screening criteria, when appropriate. Works collaboratively with departmental, revenue cycle, and clinical appeals staff, physicians, and payers to obtain authorization for care and appropriate reimbursement. Determines and assures appropriate status and level of care. Uses defined resources to guide decisions, including Medical Director Care Management, Physician Advisors, and management staff.
Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post-acute and community-based care providers to facilitate coordination of care and to enhance a seamless transition from hospital setting to the appropriate alternative level of care.
Seeks out information and resources to apply creative problem solving for complex discharge/transition planning, quality of care, and utilization management issues. Provides notification and communication to patients/families regarding coverage for hospital and post-acute services, in accordance with CMS regulations.
Documents utilization reviews, utilization management actions, care management assessment(s), care plan, discharge plan, and interventions, according to policies, procedures, and regulatory, contractual, and legal requirements. Acts proactively to see that hospital resources are utilized appropriately.
Works collaboratively with other departments to define areas of hospital inefficiency and participates in improvement projects.
This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.
How we will care for you, while you care for our patients
Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more .
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!
Optional identity theft protection, home and auto insurance, pet insurance
Traditional and Roth retirement options with service contribution and match savings
Free onsite parking
Qualifications
Required Bachelor's Degree Graduate of an accredited school of nursing.
Preferred Will consider non-BSN RN if actively pursuing a bachelor's degree in nursing with completion within 2 years of hire.
2 years of relevant experience Minimum two years' experience in the acute care setting. Required
3 years of relevant experience Three to five years' experience in care management, utilization review, home care and/or discharge planning. Preferred
Registered Nurse (RN) - State of Michigan License Upon Hire required
Primary LocationSITE - Trenton Hospital - 5450 Fort St - Trenton
Department NameCare Management - Trenton
Employment TypePart time
ShiftDay (United States of America)
Weekly Scheduled Hours20
Hours of Work8
Days WorkedMonday to Friday
Weekend FrequencyVariable weekends
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Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR,... For full info follow application link.
Beaumont Health is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, gender identity, sexual orientation, age, status as a protected veteran, or status as a qualified individual with a disability.