Assumes overall responsibility for coordinating/managing patient centered care activities for a designated cluster of patients during hospitalization, to be accomplished in collaboration with a multidisciplinary team including reimbursement, LOS, and quality of care to monitor cost effectiveness of treatment, diagnostic needs and appropriate LOS. Evaluates, develops and implements discharge plans. Performs work process, which includes securing authorization/certification for inpatient services; determining appropriateness of patient status and accomplishes positive patient outcomes. Manages patients across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes. Assures resource utilization is appropriate to patient need. Facilitates timely transitional planning and Identifies opportunities for process improvement in all aspects of work.
Five years of clinical nursing required.
RN with 5 years experience required, BSN and/ or related bachelor’s degree in a healthcare field or in lieu of bachelor’s degree; relevant experience in utilization management, case management. Active WV RN license required. Related work experience in utilization management, case management, and home care preferred. Knowledge and proficiency in utilization criteria such as InterQual. Demonstrated critical thinking skills and the ability to prioritize workload. Ability to exercise clinical judgment and autonomous decision making. Strong interpersonal skills relative to both professional and lay interactions. Strong organizational skills. Demonstrated working knowledge of performance improvement activities. Demonstrated working knowledge of data management/reporting practices. Strong communication skills
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