Registered Nurse - Case Management Specialist
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Mobile, AL 36607
Registered Nurse – Case Management Specialist
Care Management UH, AL
USA Health University Hospital
USA Health helps people lead longer, better lives through its excellence in education, research and medical care. With more than 3,600 employees, USA’s health network includes University Hospital, Children’s & Women’s Hospital, Mitchell Cancer Institute, Physicians Group, and the College of Medicine. Each year, our team of 180 physicians, 240 residents and fellows, 70 advanced practitioners and 800 nurses handle some 185,000 clinic visits and 350,000 outpatient procedures. USA Health delivers 2,800 babies a year, more than any other regional hospital, and treats patients through some 60,000 emergency room visits annually.
In addition to advanced and innovative patient care offered at University hospitals and clinics, USA’s medical education programs provide first-class training experiences for the next generation of physicians and scientists. USA Health delivers excellence in care while improving the quality of life for residents across the Gulf Coast.
USA Health is managed by the USA HealthCare Management, LLC.
Performs functions independently, according to policy and third party payor requirements, to include: quality reviews, prior authorizations, initial/admission reviews, continued stay reviews, discharge reviews, retrospective reviews, appeals as appropriate for denials, and case management reviews for DRG payors; analyzes medical record data to complete functions; collaborates with members of the healthcare team, patients, families, and managed care workers to formulate appropriate discharge plans and promote a safe and timely flow through inpatient setting; ensures optimal reimbursement from third party payors by obtaining proper authorization and facilitates the appeal process; communicates with healthcare providers via telephone, in person, and email (i.e., discussion with physicians regarding plan of care, length of stay, and stay type); establishes and maintains a professional relationship with third party payor representatives; participates in interdisciplinary patient care rounds or conferences; coordinates with medical staff and other healthcare providers on proper documentation of severity of illness and intensity of service; utilizes a PC or terminal to access the Hospital Information System; enhances professional growth and development through participation in educational programs; completes annual education on nationally recognized level of care criteria; participates in all Care Management audit activities as assigned; orients new staff to the Care Management process as assigned; reports quality of care concerns discovered during Care Management functions to the Director; maintains accurate and complete records; documents on utilization worksheet within 24 hours of admission or first working day and thereafter as appropriate; completes departmental productivity report and forms required by outside agencies; assists the attending physician in determining tests, procedures and consultations that are most appropriately done on an outpatient basis; provides continuum of care by arranging for durable medical equipment as needed for discharge, arranging home healthcare when ordered by physician, and coordinating patient/family education regarding plan of care; communicates and uses appropriate customer relation skills with physicians, patients, families and healthcare team in person and via telephone; adheres to current Infection Control and Safety Standards; responds to overhead pages; accesses and accurately maintains electronic and paper medical records; participates on committees as assigned; participates in Performance Improvement activities as assigned; regular and prompt attendance; ability to work schedule as defined and additional hours and call as required; related duties as required.
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 is preferred.
Working Days and Hours
Monday – Friday
8:00 a.m. – 4:30 p.m.