Position Summary: The registered nurse is responsible for the assessment, planning, implementation, and evaluation of the patients’ status, plan of care, and goal achievement. Utilizes the nursing process and approved criteria (as applicable) to determine appropriateness of admission and appropriate level of care for patients. Collaborates with physicians and staff to ensure patients are placed in the correct patient status. Communicates with payers regarding appropriate level of care, benefits, and financial resources available for patient care. Maintains documentation for insurance authorization, contacts, and records of transactions for each inpatient. Collaborates with the Patient Finance Department to ensure appropriate billing status. Care is provided in a compassionate, professional, ethical, and knowledgeable fashion based on the Caring Model, exemplifies the mission, vision and values of Rush Copley, and is in accordance with policies and procedures. The registered nurse is expected to uphold the most ethical and safe processes while keeping the care of the patient as a top priority. The position works closely with the entire multidisciplinary team and must have a complete understanding of own limitations and, in turn, seek advice, judgment and support of others, when necessary.

 

JOB RESPONSBILITIES

Utilizes evidence-based criteria to assess appropriateness of patient admission and level of care. Provides continuous review of medical necessity and SI/IS criteria. Notifies physician and collaborates with Physician Advisor when documentation indicate patient does not meet criteria. Responsible for documentation of appropriate patient status. Assesses patients' health care needs, monitors patients' progress, and confers with physician practice group and health care team regarding variances from the anticipated plan of care. Provides basic assessment of patient's psychosocial, financial, cultural, and family situation. Coordinates social services for patients and families to address needs. Seeks assistance as needed regarding in-depth psychosocial needs. Manages a complex patient caseload and demonstrates expert ability to coordinate and implement discharge management services and provide continuity of care planning. Finds community resources for potential sources of assistance, maintains contact with community resources, and consults with physicians and inpatient groups regarding use of community resources Reviews admissions and ongoing stays of patients with respect to the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process. Works with physicians and Medical Director regarding Case issues and concurrent denials an indicated.

 

POSITION REQUIREMENTS

License: Current state of Illinois Registered Nurse license required.

Education: Bachelor’s Degree in Nursing preferred. For hires or transfers on/after 8/1/2013, must attain a BSN within 5 years of hire/transfer date.

Special Skills:

Strong leadership and role model skills to effectively assist unit staff and physicians in understanding managed care techniques and the value of changing practice patterns. Excellent negotiation skills with physicians and others to assure patient receives appropriate and timely care. Effective analytical, organizational, written and verbal communication skills. High level of interpersonal skills for interacting with all level of professionals within and outside the organization. Able to multitask in an organized manner; high degree of flexibility required self-directed learner and professional. Working knowledge of word processing software/hospital information systems.

Experience:

Knowledge of concepts and principles of Care/Utilization Management Hospital experience preferred. Two years’ experience with direct patient care for the neonate, pediatric, adolescent, adult and/or geriatric patient and expert