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Utilization Case Manager RN, Decatur

Location: Decatur, TX
Date Posted: 12-27-2017
  • Conducts chart assessments on hospital patients on a daily basis and documents such in Clinical Suites system; provides clinical information to insurance as requested using Interqual Criteria guidelines to establish appropriateness of admit and documents same in MS520 system. 
  • Exemplify sound clinical judgment and experience and expertise in area of clinical management and demonstrate skill in clinical chart assessment and ability to communicate effectively with physicians and staff. 
  • Communicate with precertification nurse to facilitate on going coverage and work closely with social workers to provide maximum assessment of discharge needs. 
  • Assists with providing information on advance directives and also, when asked, assists patients in formulating advance directives; provides discharge planning from the hospital setting by communicating with physician and providing information regarding Interqual Criteria and appropriate level of care.
  • Participates in patient care conferences and communicates with staff/treatment/physician team on appropriate interventions; attends daily conference meeting with Case Management Staff to discuss patient status; and maintains positive working relationships with staff and other departments to provide optimal quality outcomes within the framework of professional nursing practice. 
  • These responsibilities are met according to hospital policy, hospital mission statement and the philosophy of the Department of Nursing. 
  • Also requires basic knowledge and operational skills of computer and office equipment; ability to move around various areas of the hospital quickly / extensive walking; possess the ability and desire to work with individual of all races, ages, lifestyles, disabilities and cultures; excellent oral and written communication skills; and must be willing to work as a member of the total healthcare team.
  • Operationally, reports to the Director Integrated Clinical Documentation Improvement
  • 1) Current  TX RN licensure by the State Board of Nurse Examiners with basic knowledge of appropriate nursing applications 
  • 2)  Current CPR
Must have current licensure/certifications upon hire. 

New Hires will have 60 days to acquire the required Basic Life Support (CPR, ACLS, PALS, BLS, and/or any other life support certifications required for the job).
  • There is no anticipated risk of exposure to mucous membranes or skin contact with blood, body fluids, or tissues, or a potential for spills or splashed during the performance of the job. 
  • Universal precautions must be observed and protective devices worn by the employee when performing a task that is likely to cause exposure.
Employment standards include current requirements as determined by Federal, State, and Wise Health System policy.
  • Non-Exempt Hourly 
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