Access Case Manager (Utilization Review) RN

Position Summary / Career Interest:

The Access Case Manager (CM), under the direction of the Director/Manager of Case Management functions as a member of the interdisciplinary healthcare team in the provision of patient care with the underlying objectives of enhancing the quality of clinical and financial outcomes and patient satisfaction while managing the plan of care. Within the purview of financial management, pro-actively communicates with members of the healthcare team to ensure appropriate medical necessity for patients in beds; Serves as an effective liaison to ensure continuity and integration of services and accurate assignment of patient status. Communicates with payers and patient/family/healthcare team regarding payer information as necessary. Ensures that patient care moves through the continuum in a timely and efficient manner.

Responsibilities:

• Accepts responsibility and accountability for achievement of optimal outcomes within their scope of practice. Follows policies, procedures and standards; complies with Corporate Compliance program. Assumes responsibility for risk and safety issues associated with the position. Takes call as required by the department expectations. Performs specific job responsibilities and demonstrates accountability for own actions and decisions.
• Acquires and maintains knowledge and competence related to the expectations of their position and practices within their scope. Brings ideas and concerns to supervisor, participates in department decision making. Maintains current licensure.
• Performs high level screening, assessment, and planning to enhance and support Direct Admission, Transfer Center, and procedural area patient flow.
• Appropriately screens patients for level of care (LOC) and ensure clinical information in the medical record is clear and accurately reflects LOC requested.
• Partners with medical staff to improve overall quality of the clinical documentation and establish accurate assignment of patient status orders (e.g., Observation/Inpatient).

*Must be able to perform the professional, clinical and/or technical competencies of the assigned unit or department.

*Note:  These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities.  Skills and duties may vary dependent upon your department or unit.  Other duties may be assigned as required.

JOB REQUIREMENTS

Required:

• Bachelor's Degree in Nursing
• Registered Nurse in State of Kansas required
• Minimum two (2) years clinical experience required

Preferred:

• Master's Degree in Nursing
• Minimum two (2) years clinical experience in health care setting preferred

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.

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