Job Description

Description

• Coordinates care and services for particular population of patients including conducting utilization review, establishing proper admission status in conjunction with the physician, facilitating patient and/or family participation in decision making regarding treatment and overseeing discharge plans.
• Works collaboratively with providers to arrange post-discharge care and services in a timely manner, involving the patient and/or family in developing discharge plans.
• Conducts admission and continued stay reviews for medical necessity, severity of illness and intensity of service. Coordinates proper admission status with the physician and obtains authorization for reimbursement in a timely manner.
• Develop and maintain a collaborative team to evaluate and create process for denied authorizations in an effort to improve process and eliminate loss of revenue.
• Provide quality psychosocial needs to patients and their family by formulating a diagnostic impression.
• Provides efficient methods of work processing and workflow for the utilization function required with patient management.
• Oversight and coordination of all patients admitted to swing bed program.
• Complete initial review of potential swing bed patients, including appropriateness, review with accepting provider on call.
• Update polices on case management, utilization review and swing bed.
• Function effectively in an independent manner.

Requirements

BLS required upon hire and maintained throughout employment. Master's degree in Social work or a graduate of an accredited school of nursing and currently licensed to practice in the State of Michigan. 2-3 years of case management and/or utilization review experience preferred.

Job Tags

Full time,

Similar Jobs