Utilization Review Rn Jobs in Flowery Branch, GA

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Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.

Responsible for providing comprehensive assessment, planning, implementation and overall evaluation of individual patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure patient management that efficiently and effectively aligns with patient needs using resources to meet quality, clinical and cost effective outcomes. Coordinates a team approach designed to facilitate the achievement of expected patient outcomes with appropriate transitions to the next level of care; Responsible for length of stay management, regulatory compliance, and attending/participating with interdisciplinary team rounds on assigned unit; Collaborates with community providers to facilitate and coordinate the plan of care for post-hospitalization needs of the patient. This position will come in contact with patients in the neonate, infant, child, adolescent, adult, and geriatric age groups; Employees will perform clinical duties in accordance with population specific guidelines and adhere to National Patient Safety Guidelines. Provides cross coverage for all RNCM as required across all settings in the care continuum, including weekend rotation (as needed).

• Licensure or other certifications: Licensed to practice as an RN in Georgia.

• Educational Requirements: Associates Degree. Graduate of an accredited school of nursing.

• Minimum Experience: Three (3) to five (5) years of experience in direct patient care and/or case management.Financial and discharge planning experience.

• Other:

• Preferred Licensure or other certifications: CCM (Case Management Certification) or ACM (American Case Management Certification) preferred.

• Preferred Educational Requirements: Bachelors Degree

• Preferred Experience:

• Other:

• Demonstrates aptitude in critical care, cardiac, medical, and/or surgical nursing

• Working knowledge of State and Federal regulations required

• Must demonstrate excellent observation skills, analytical thinking, problem solving abilities, and be self directed

• Excellent oral and written communication skills

• Demonstrates interpersonal skills including professionalism, a team player, pleasing personality and positive approach to the position

• Demonstrates the ability to think outside of the box and consistently create new, and effective solutions to today's problems and opportunities

• Monitor all patients on assigned units to ensure appropriate use of resources and interventions while managing patient's length of stay based on working DRG/admitting diagnosis.

• Communicates with Physician, patient/family, and other disciplines the expected length of stay, along with patient progress towards discharge.

• Provides coordination and facilitation oversight of patient care to assure required interventions occur in proper sequence and processes occur in a timely manner without delays. Identifies and acts upon potential delays in services; escalates unresolved delays to management for appropriate intervention.

• Assess, coordinate and facilitate patient's discharge plan to assure post-acute needs are arranged and secured prior to discharge; Communicate discharge plan with Physician, patient/family, and other members of the healthcare team as appropriate; Reassess discharge plan routinely throughout patient's stay to ensure timely, safe discharge and appropriate transition to the next level of care. Provides patient/family with information regarding their plan of care, discharge and any financial responsibility of inpatient or post-hospitalization services.

• Maintain knowledge of reimbursement methodologies and general coverage guidelines for all levels of inpatient and outpatient care. Communicate with Physician, patient/family or other team members as needed to ensure services will be covered.

• Coordinate and communicate with Utilization Review Nurse on a daily, consistent basis to ensure patients are in the right status and level of care. Facilitate changes by communicating with Physician, mid-level or nursing staff as needed.

• Serve as liaison to patients family, Physicians, nursing staff and all other disciplines to achieve optimal outcomes in the development of patient's discharge plan. Serve as a leader on assigned unit in the areas of discharge planning, social service issues, community resources/referrals and financial information related to patient care and outcomes. Empowered to think outside of the box to consistently create new, and effective solutions to complex problems or opportunities.

• Actively supports a customer service oriented environment to continually enhance customer service; Communicates directly with Physicians, nursing staff, patient/family and other disciplines to ensure collaborative practice. Provide appropriate hand-off communication as patients transition from one unit to another to ensure and achieve optimal outcomes.

• Maintains positive attitude, and communicates appropriately with patients/families, Physician, management and other staff; responds positively to change and offers suggestions to effectively incorporate change as needed in daily workflow.

• Maintain detailed knowledge of community resources, governmental regulations, third party payers (PPO/HMO's) to facilitate appropriate outcomes.

• Adheres to all regulatory and DNV requirements; Knowledgeable of third party/governmental payer regulatory requirements and adheres to appropriate processes. Completes paperwork as required.

• Consistently demonstrates a 'sense of urgency' in his/her work, while mindful of the pillars and financial stewardship opportunities.

• Works all scheduled shifts, including weekend rotation, and remote coverage.

• Weight Lifted: Up to 20 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 20 lbs, Occasionally 0-30% of time

• Vision: Moderate, Occasionally 0-30% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Occasionally 0-30%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Frequently 31-65%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding

Working at NGHS means being part of something special: a team invested in you as a person, an employee, and in helping you reach your goals.

NGHS: Opportunities start here.

Northeast Georgia Health System is an Equal Opportunity Employer and will not tolerate discrimination in employment on the basis of race, color, age, sex, sexual orientation, gender identity or expression, religion, disability, ethnicity, national origin, marital status, protected veteran status, genetic information, or any other legally protected classification or status.