Current Career Opportunities at Oaklawn

JOB SUMMARY:   Responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning.  Responsible for ensuring compliance with DNV provisions of care regarding discharge planning and patient needs for care, treatment, and services after discharge or transfer are met. Responsible for assisting in carrying out the hospital’s Utilization Management Plan.  Educates staff regarding effective allocation of the hospital’s resources, while encouraging provision of high quality patient care.  Is cognizant of regulations and policies of all review organizations relating to billing of the fiscal intermediaries.  Coordinates, monitors and evaluates options and services to meet an individual’s health needs.  Provides a full range of case management services in collaboration and communication with other staff members.  Assesses, plans, implements, coordinates, monitors, and evaluates options to facilitate the continuum of care.

ESSENTIAL FUNCTIONS:

• Consistently uses an outward mindset and puts forth exemplary effort in accomplishing his/her goals and objectives in a manner that helps others to achieve their goals and objectives.
• Coordinate the integration of social services/case management functions into the patient care, discharge, and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities.
• Responsible for evaluating and screening potential admissions to the facility when appropriate.
• Knowledgeable of criteria for Medicare, Medicaid, HMO and private insurance coverage when performing utilization review functions.
• Conducts review and collaborates with payers and review organizations to ensure appropriate utilization of patient care services from admission through discharge.
• Ensure that patient tests are appropriate and necessary and are carried out within the established timeframe and that results are promptly available.
• Assist physicians, patients, families, staff and payers in providing care for patient populations that is appropriate, effective, and cost efficient.
• Documents clearly and concisely all contacts and information of the patient’s case management process in the medical record.
• Initiates and presents “denial letters”, as appropriate.
• Educates physicians and staff regarding appropriate level of care and utilization issues to maintain appropriate cost, case and desired patient outcome.
• Introduces self to patient and family and explains clinical case manager role and process for patient and family to contact clinical case manager.
• Participates in the data collection and analysis as required by department, hospital or various agencies.
• Maintains and enhances professional growth and development through attendance at seminars, conferences and continuing education offerings.
• Performs other duties as assigned, including recipient rights advisor/officer.

Minimum Qualifications:  Associate’s degree in Nursing, Licensed in the state of Michigan.  Five (5) years of experience working as a registered nurse in an acute hospital setting.

Knowledge, Skills & Abilities:  Ability to work with diverse patient and staff populations with knowledge and sensitivity to cultural and spiritual influences impacting patient care.  Demonstrated ability to efficiently and independently manage own time and tasks with minimal supervision.  Knowledge of state and federal programs that provide medical care and financial support to individuals and community resources.  Knowledge of the Continuum of Care and Utilization processes.  Ability to read, analyzes, and interprets professional journals, technical procedures, or governmental regulations.

Working Conditions:  May experience traumatic situations including psychiatric, dismembered and deceased patients.

Physical Requirements:  Constantly see/visual acuity, talk/hear.   Frequently stand, sit, walk, handle/grasp/feel. Occasionally lift/carry 1 to 50 lbs.