Job Description
Pay Range: $27.
52-$41.
22 per hour
Position Summary
To perform review activities relative to assuring appropriate utilization of hospital services, assessing, facilitating and obtaining appropriate resources for identified continuing care needs.
Assessing patients, beginning with the admission review, to determine medical necessity, appropriate level of care and potential needs after discharge, and to initiate the discharge planning process.
Communicates review findings to physicians, managed care organizations, insurance companies, long-term and/or home care facilities, patients and families.
Job Duties
Assesses and evaluates patients for appropriateness of transfers to other facilities and facilitates transfers and/or placements as needed; completes necessary transfer documents and notifications.
Communicates difficult and/or problematic cases to the manager as indicated; provides periodic updates to the manager regarding changes in patient status and/or concerns.
Communicates level of care information and treatment plans to insurance companies, managed care organizations, home health and/or long term care facilities.
Confers with patient and families regarding available resources for post discharge needs and coordinate needed resources.
Confers with patients regarding insurance benefits as it relates to the necessary level of care and/or discharge planning needs.
Coordinates community health resources for patients and patient families in the outpatient and mental health care areas.
Discusses cases with interdisciplinary team members as needed to optimize the discharge plan.
Keeps abreast of changes in utilization management and discharge planning by attending in- services programs/workshops and reading current literature.
Refers questionable cases relative to discharge planning activities to the leadership for follow-up.
Reviews medical records of patients currently hospitalized to evaluate level of care, to assess continued need for acute care and to assess potential need for community resources after discharge; to confer with physicians, nurses, and other appropriate hospital personnel to determine and document appropriateness of patient admission and continued need for hospital care; collect data as appropriate.
Performs other duties as assigned.
Job Requirements
Qualifications
A combination of years of experience and relevant education will be considered in place of the above preferred education based on organizational need.
Effective written and oral communications skills - Required.
Ability to communicate in a tactful, non-threatening manner - Required.
Utilization management or discharge planning experience minimum 1 year - Preferred.
Strong organizational and prioritization skills - Required.
Effective critical thinking skills - Required.
BLS Certification within 6 months of hire - Required.
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