PRN (As Needed) 8:00am-4:30pm May be asked to work weekdays/weekends/holidays when coverage is needed to maintain adequate staffing General Summary Performs a variety of duties and applies utilization and case management techniques to determine the most efficient use of resources to facilitate a patient's progression of care and the provision of appropriate, cost effective and quality health care. Works in a team model with social work in assigned patient care areas to address patient discharge needs. Provides leadership in the integration of utilization and case management principles. Duties and Responsibilities Essential Functions: • Reviews assigned patients for medical necessity, utilization management, and appropriateness of setting for continued hospitalization. • Initiates problem-solving techniques to prevent over and/or under utilization. • Facilitates and coordinates the progression of patient care to optimize throughput and the utilization of resources to support continuous quality and cost of care efforts. • Liaisons between utilization management team, third party payers, and the treatment team regarding the identified treatment plan in accordance with contractual guidelines and System policy. • Assists the patient care team with the identification and coordination of alternative treatment settings to provide appropriate care, maintain quality of care, and reduce cost. • Identifies conditions which require case management across the care continuum. Collaborates with members of the patient care team to identify interdisciplinary needs • Collaborates with care management across the system to effectively transition patient care and support value-based care initiatives. • Completes case management patient assessment, identifies needs, develops a discharge plan, and coordinates discharge needs (DME, Home Health, IV antibiotics, etc.) in collaboration with patients, families, and care team. • Assists with the collection and analysis of utilization patterns, length of stay, readmissions, avoidable days, and denied cases. • Brings known or suspected problems of under-, over-, or inappropriate utilization of resources to the attention of the appropriate manager(s). Common Expectations: • Demonstrates a commitment to patient, visitor, and staff by complying with all applicable safety regulations, learning the impact of medical errors and methodology that will lead to reduction of errors; reporting actual and potential errors, as well as hazardous conditions; identifying opportunities to standardize processes and “error proof” systems that will lead to increased safety; and participating in safety education programs and root cause analyses as required. • Prepares and maintains appropriate documentation as required. • Maintains established policies and procedures, objectives, quality assessment and safety standards. • Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation. • Prepares and presents utilization data analysis as required. • Participates in the development and delivery of educational information and process improvements related to job accountabilities and case management principles. • Attends meetings as required. Qualifications Minimum Education: • Associates Degree Required • Bachelors Degree Preferred Work Experience: • 2 years Recent Acute Care experience. Required • Field of experience in Utilization Management, Case Management, or Clinical Nursing Specialty. Preferred Licenses: • Licensed Registered Nurse Upon Hire Required or • Registered Nurse Multi State License Upon Hire Required and • Basic Life Support Upon Hire Required • Certified in Case Management Preferred Knowledge, Skills, and Abilities: • Excellent interpersonal and communication skills. • Basic computer skills. • Desire and ability to work in a supportive and collaborative team environment.