Case Manager PRN

Overview:

Provides discharge planning and utilization review services in compliance with patients discharge planning needs and the hospital’s utilization review program.

**SAFETY SENSITIVE POSITION:**

This position is a designated as “Safety Sensitive Position” under Act 593 of the State of Arkansas. An employee who is under the influence of Marijuana constitutes a threat to patients/customers which Conway Regional is responsible for in providing and supporting the delivery health care related services.

Qualifications:

* Registered Nurse or Licensed Practical Nurse with current, active license to practice in Arkansas, required
* Proof of the highest level of nursing education achieved, required
* At least one-year experience in the area of case management/utilization review, preferred

Responsibilities:

* Apply clinical knowledge to determine appropriate acuity levels and utilization through chart review.
* Effectively organizes workflow to consistently complete assignments in a timely manner.
* Demonstrates ability to access and effectively utilize primary sources of data.
* Obtains and maintains medical records in conformance with Medical Information policies.
* Communicates with co-workers in a manner that is conducive to positive and effective working relationships. Demonstrates respect, honesty and integrity when working with other service providers.
* Demonstrates compliance with all relevant hospital, state and federal requirements related to maintenance of confidentiality of persons, data and information systems.
* Takes advantage of opportunities made available through CRHS and other professional organizations for continued professional growth and development.
* Responsible for analysis of patient information for determination of necessity of admission or continuation of stay.
* Review for medical necessity of admission on the first working day after admission using approved review criteria.
* Reviews inpatient procedures to determine appropriate utilization and acuity level. Reviews potential for outpatient setting or swing bed utilization.
* Reviews all patients for medical necessity of continued stay, or before the next review date, using approved review criteria.
* Performs retroactive reviews, as necessary, and responds to the appropriate review agency or third party payor.
* Researches denials issued by review agencies and third party payors and responds within the specified time frames for appeal.
* Works with others on healthcare team to coordinate for patients discharge needs.
* Establishes an effective utilization review process and maintains an active, effective utilization review file system. Recommends, develops and revises policies related to the utilization review process.
* Works collaboratively with physicians, Case Management, the discharge planning process, Admissions, Central Scheduling and other CRHS associates.
* Educates staff, physicians and other personnel regarding medical necessity requirements as defined by approved review criteria.
* Assists with other department functions as assigned.