Job Posting
RN/Case Manager
DEPARTMENT: Hospital Nursing
JOB SUMMARY: Plans, organizes, and implements Swing bed services and activities while consulting with healthcare team to determine patient needs and treatment options. Identifies needs for Swing bed patients and nursing staff in an effort to facilitate morale and teamwork.
Monitors and compiles information on the necessity of the admission of patients to the hospital and on the continued stay of patients by reviewing patient’s records. Assures the hospital and medical staff complies with federal and state requirements for quality of patient care and optimum utilization.
OSHA Bloodborne Pathogens Class I
JOB QUALIFICATIONS:
A. Education: Graduate of an accredited School of Professional Nursing, Licensed Vocational nursing or of program.
B. Personal Job-Related Skills: Knowledge of medical terminology and effective oral and written communication abilities. Knowledge of Medicare, Medicaid, and welfare programs. Bilingual (Spanish) preferred.
C. Licensure, Registry or Certification: RN currently licensed by the State of Texas or certification as an ART or RRA.
D. Experience:
1. Prior Work Experience: Two years’ experience in a hospital setting. Experience in quality assurance or utilization review activities preferred.
2. Technical Training: None required.
E. Physical and Mental Requirements: Duties of the position require moderate periods of standing and walking. Duties of the position require moderate periods of walking and standing. Pushing, pulling, reaching, and bending when involved in patient care. Lifting up to 50 pounds and occasional heavy lifting in supporting or moving patients that may suddenly become weak or helpless.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
1. Identifies patients that require swing bed services.
2. Interviews patients identified by our facility or an outside referring agency to determine best placement.
3. Consults with the healthcare team to identify patients’ needs and treatment options.
4. Coordinates the information leading up to transition of care.
5.Determines patients’ eligibility for swing bed through the multidisciplinary team members
•Physical therapy, Occupational therapy, speech therapy or wound therapy
•Pharmacy-notification to that department for medications needed for the swing bed patient.
•DON or Representative notification and acceptance for need for nursing services
•Insurance verification
•Physician approval-contacted once need has been identified and insurance has been verified.
6. Works with Physician to obtain admission orders
7. Completes admission process and instruction
•Services available
•Requirements to remain eligible
•Floor routine
•Physician routine
•Leaving facility on pass
•information packets
8. Works with patient/family regarding discharge plans and community resource arrangements prior to discharge.
•Home health
•Out Patient Services
•DHS primary care
•Follow up Specialty appointments
•Assisting in Skilled Nursing Facility placement if needed
9. Monitors and compiles information regarding the necessity of admission and continued stay for all admissions.
10. Reviews patients records to assemble utilization review information.
11. Conducts admission and continued stay reviews on all Medicare, Medicaid, and some non-federal covered patients.
12. Communicates with the physician advisor regarding utilization review concerns, such as, when questions arise concerning an admission, when recertification of a patient is required, or when the need for continued stay is questioned.
A. Maintains records and supports the hospital in utilization matters.
1. Completes accurate, timely records for submission to the business office to coordinate billing flow between the hospital and outside agencies.
2. Assists by providing information and utilization records in appeals for redetermination.
3. Prepares and presents education sessions and materials for medical staff members and the hospital staff.
4. Assists with interaction of all fiscal intermediaries regarding utilization review activity.
5. Compiles and reports statistics to the Utilization Review Committee.
B.Activities Coordinator Duties:
1.Arranges for swing bed patients to attend activities or to participate in activities in their room.
2.Checks on all hospital floor patients to offer distraction (i.e., reading materials, mail, channel surfing, music, relaxation exercises, etc.) as needed.
3. Plans holiday treats at appropriate times
 This can include:
a. Patient birthdays
b. Christmas
c. Lent
d. Memorial Day, etc.
By offering:
a. Edible treats (within diet specifications)
b. Note cards
c. Marketing souvenirs
4.Works with patient and family when a request is made for large group activity surrounding a family event for a patient.
5.Works with ministerial alliance regarding:
Notifications when church member is admitted
Identifying patients agreeable to rounding for prayers
C.Patient/Staff Advocate Duties:
1.As a patient advocate, identify need for additional services
24-hour care
Mail run
Coordination visits from family/friends/church group for patients who are struggling
Providing indigent services
Assist with finding assistance programs
2.Build a network of federal, state, and community resources.
3.Maintain records for all assistance programs used and persons helped through these services.
4.Staff Advocate
Morale committee
Employee assistance committee
Staff morale builders
Birthday cards
OTHER SIGNIFICANT REQUIREMENTS:
A. Maintains confidentiality while working with confidential matters on a daily basis.
B. Provides service direct to patients while maintaining a positive patient relations atmosphere.
C. Interacts with patients, family members, medical staff members and other department managers on a continuous basis.
D. Conducts patient satisfaction surveys as required.
E. Follows safety guidelines and infection control policies for the Hospital District.
Additional Information
Position Type : Full Time
Shift : Day
Contact Information
HR Support
HR
Email: hrsupport@dhchd.org |
