Bayhealth
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Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!
Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:
Generous Paid Time Off and Paid Holidays Matching 401(k)/403(b) Plans Excellent Health, Dental, and Vision Disability and Life Insurance options On Site Child Care Educational Reimbursement Health Care and Dependent Care Flex Spending Accounts Plus, an array of Voluntary Benefits to include Critical Care Coverage and more! Location: Sussex Campus Hospital
Status:
Full Time 80 Hours
Shift:
Days
SALARY RANGE:
37.98 - 58.87HOURLY
General Summary:
An RN who coordinates care and services of selected patient populations across the continuum of illness promoting effective utilization and monitoring of health care resources. Performs concurrent and retrospective patient reviews based on accepted quality, utilization, clinical risk and infection control criteria and communicates effectively with all members of the health care team regarding issues identified.
Responsibilities:
1. Applies utilization management criteria for the review process, distinguishing levels of care and interacting with Physicians, other healthcare team member, and outside agencies. 2. Conducts patient screening for assessment of discharge planning interventions. Conducts simple discharges which include home health care, durable medical equipment, and authorizations pharmaceuticals. Provides communication to the Social Worker for complex discharge needs. 3. On a concurrent basis, assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; performance and clinical risk issues; and documentation of medical record completeness and reports all variances and events. 4. Accurately and completely records all required clinical data in the data base to include information for reconsideration letters for denial of days and/or service. 5. Demonstrates ability to perform the Medicare denial process. 6. Recognizes urgent utilization issues and reports them to the Care Management manager, unit management, and attending physician immediately 7. All other duties as assigned within the scope and range of job responsibilities 8. ED Care Managers ONLY: Through an interdisciplinary team of health care providers, the care manager in collaboration with the physician will assist in coordinating a comprehensive plan of care using a concurrent integrated review process to determine medical necessity for appropriateness of admission. If admission is not appropriate then assist in a collaborative effort with the patient and significant other to enhance quality of care and focus on appropriateness of outpatient resource use. 9. Responsible, in coordination with the physician in developing and reviewing the individualized care plan, therefore assisting with the implementation of the plan of care. Communicate the plan of care with the entire health care team members. Facilitates the efficient delivery of care. 10. Assists the physicians with documentation compliance according to Medicare, Medicaid and Commercial payer regulations and guidelines. 11. Demonstrates ability to combine medical staff practice patterns, disease trajectory, community resource knowledge, and patient family desires into the critical thinking of discharge planning. Acts collaboratively with the emergency room navigator to coordinate discharge plans and arrangements for patient / families by ensuring a smooth transition from an emergency room level of care to another as required. 12. Conducts the initial assessment for the identification of potential discharge needs and provides communication to the Social Service Inpatient Discharge Planners. 13. Non-ED ONLY: Performs concurrent denial recovery of all denied days and records outcomes in the clinical data base. Requests sub-acute level of care when applicable to denied days. 14. Acts collaboratively with Social Services for post-hospital care needs
Required Education, Credential(s) and Experience:
Education: Bachelor Degree ; Nursing ; Credential(s): Registered Nurse Basic Life Support ; Experience: Required: 5 years nursing experience within the last 10 years Preferred: Utilization Review, Care/Case Management experience Preferred Education, Credential(s) and Experience:
Education: Credential(s): Certified Case Manager Certified Professional in Utilization Review Experience:
To view a full list of all open position at Bayhealth, please visit:
https://apply.bayhealth.org/join/
Bayhealth Medical Center is Central and Southern Delaware's healthcare leader with hospitals in Dover and Milford, as well as stand-alone Emergency Department in Smyrna and a hybrid Emergency Department and Urgent Care in Milton. We offer various practice settings throughout Kent and Sussex Counties. Bayhealth Medical Center Kent Campus is 90 minutes from Philadelphia, Washington, DC and Baltimore. Our Sussex Campus is 30 minutes to the Delaware beaches and relaxation in the sand!
Bayhealth Medical Center offers a competitive salary and comprehensive benefits package (for eligible positions) including:
Generous Paid Time Off and Paid Holidays Matching 401(k)/403(b) Plans Excellent Health, Dental, and Vision Disability and Life Insurance options On Site Child Care Educational Reimbursement Health Care and Dependent Care Flex Spending Accounts Plus, an array of Voluntary Benefits to include Critical Care Coverage and more! Location: Sussex Campus Hospital
Status:
Full Time 80 Hours
Shift:
Days
SALARY RANGE:
37.98 - 58.87HOURLY
General Summary:
An RN who coordinates care and services of selected patient populations across the continuum of illness promoting effective utilization and monitoring of health care resources. Performs concurrent and retrospective patient reviews based on accepted quality, utilization, clinical risk and infection control criteria and communicates effectively with all members of the health care team regarding issues identified.
Responsibilities:
1. Applies utilization management criteria for the review process, distinguishing levels of care and interacting with Physicians, other healthcare team member, and outside agencies. 2. Conducts patient screening for assessment of discharge planning interventions. Conducts simple discharges which include home health care, durable medical equipment, and authorizations pharmaceuticals. Provides communication to the Social Worker for complex discharge needs. 3. On a concurrent basis, assesses the appropriateness of the level of care; diagnostic testing and clinical procedures; performance and clinical risk issues; and documentation of medical record completeness and reports all variances and events. 4. Accurately and completely records all required clinical data in the data base to include information for reconsideration letters for denial of days and/or service. 5. Demonstrates ability to perform the Medicare denial process. 6. Recognizes urgent utilization issues and reports them to the Care Management manager, unit management, and attending physician immediately 7. All other duties as assigned within the scope and range of job responsibilities 8. ED Care Managers ONLY: Through an interdisciplinary team of health care providers, the care manager in collaboration with the physician will assist in coordinating a comprehensive plan of care using a concurrent integrated review process to determine medical necessity for appropriateness of admission. If admission is not appropriate then assist in a collaborative effort with the patient and significant other to enhance quality of care and focus on appropriateness of outpatient resource use. 9. Responsible, in coordination with the physician in developing and reviewing the individualized care plan, therefore assisting with the implementation of the plan of care. Communicate the plan of care with the entire health care team members. Facilitates the efficient delivery of care. 10. Assists the physicians with documentation compliance according to Medicare, Medicaid and Commercial payer regulations and guidelines. 11. Demonstrates ability to combine medical staff practice patterns, disease trajectory, community resource knowledge, and patient family desires into the critical thinking of discharge planning. Acts collaboratively with the emergency room navigator to coordinate discharge plans and arrangements for patient / families by ensuring a smooth transition from an emergency room level of care to another as required. 12. Conducts the initial assessment for the identification of potential discharge needs and provides communication to the Social Service Inpatient Discharge Planners. 13. Non-ED ONLY: Performs concurrent denial recovery of all denied days and records outcomes in the clinical data base. Requests sub-acute level of care when applicable to denied days. 14. Acts collaboratively with Social Services for post-hospital care needs
Required Education, Credential(s) and Experience:
Education: Bachelor Degree ; Nursing ; Credential(s): Registered Nurse Basic Life Support ; Experience: Required: 5 years nursing experience within the last 10 years Preferred: Utilization Review, Care/Case Management experience Preferred Education, Credential(s) and Experience:
Education: Credential(s): Certified Case Manager Certified Professional in Utilization Review Experience:
To view a full list of all open position at Bayhealth, please visit:
https://apply.bayhealth.org/join/