Reliant Medical Group is seeking a Clinical Nurse to join our exciting and innovative organization!
Full Time: 40 hours per week 8:30am-5:00pm Monday-Friday
Responsible for conducting concurrent and retrospective utilization review for inpatient and/or observation services.
Creates and implements the discharge plan to insure optimum outcomes after discharge from the inpatient setting including arranging for home and/or skilled facility services; insuring appropriate elements are in place to prevent readmissions; arranging for and enrolling patients in appropriate disease and case management programs; evidence based evaluations of alternative discharge locations; and active management of discharge to skilled nursing facilities. Works independently and collaboratively as a facilitator with other patients of the health care team to ensure that patients receive quality, cost-appropriate care.
Supports the attending medical staff in adhering to appropriate care paths and clinical care guidelines identifying and supporting management of gaps in care.
Manages the patient’s benefits to insure the most appropriate course of therapy in the most appropriate setting of care including identification of alternative benefit packages that might more appropriately meet the patient’s medical and social needs. Supports the medical and social needs of patients approaching end of life.
Ability to work both independently and collaboratively with other patients of the health care team using established procedures to assure timely completion of assigned work in conformance with established departmental policies and standards; problems lacking clear precedent are reviewed with Manager prior to taking action.
Presents clear definition of problem(s) and opportunities when reviewing with Director; Medical Director, attending physician, or Hospitalist.
Graduate from an accredited school of nursing.
License: Active, unrestricted licensure as a Registered Nurse in Massachusetts; current Massachusetts driver’s license.
Certified in Case Management preferred. A minimum of three to five years clinical experience as a Registered Nurse in an inpatient setting required preferable with older patients.
One year experience as a case manager in a payor or facility setting highly preferred. Disease Management or Care Coordination experience a plus.
Excellent communication, interpersonal and organizational skills. Proficient in computer use, the Internet and health information technology.
Ability to travel frequently to hospitals, skilled nursing facilities, patient’s homes and other sites where patients received care.
Proficient in computer use, the internet and health information technology.
Previous experience with concurrent reviews and Interqual criteria a must have.