Case Management Specialist - Utilization Review Nursing Hours: 7A-7:30P WEO Days - Full-time Paygrade/Wages/Salary Info: 20H -
Job Summary Facilitates cost-effective, quality patient outcomes and transitions by determining the appropriate level of care and providing guidance, education, and support to assigned patients. # Job Responsibilities Assessment of complete chart and knowledge of patient#s medical condition, financial status, emotional needs, and support systems. Conducts initial and concurrent reviews of clinical documentation for medical necessity and appropriate level of care using approved criteria within specified time frame. Provides appropriate clinical information to payers as requested within specified time frame. Collaborates with the Attending Physician, Physician Advisor, Director, Manager, or Supervisor of Case Management on patients who are not meeting the regulatory requirements for hospitalization and delays in services and/or discharge. Delivers regulatory letters to patients as needed. Works in collaboration with the interdisciplinary team to ensure quality support of care and resource information May assist patients/families with referrals to community agencies, post-acute providers, and/or provide education and resources. Provides education and acts as a resource for physicians, staff, and patients/families regarding case management processes. Trains new case managers, students, and interns as needed. Qualifications Associate#s degree or higher in Nursing required upon hire AND Bachelor#s degree or higher in Nursing required within 5 years of employment in this position No experience required RN - Licensed as a Registered Nurse. Eligible to practice nursing in the State of Kentucky required upon hire Skills and Attributes Requires critical thinking skills and decisive judgment. Works under minimal supervision. Must be able to work in a stressful environment and take appropriate action. Physical Demands Standing: Frequently Walking: Frequently Sitting: Frequently Lifting 0-25 lbs: Frequently Lifting 25-75 lbs: Rarely Lifting over 75 lbs: Rarely Carrying 0-25 lbs: Frequently Carrying 25-75 lbs: Rarely Carrying over 75 lbs: Rarely Pushing/Pulling 0-25 lbs: Frequently Pushing/Pulling 25-75 lbs: Frequently Pushing/Pulling over 75 lbs: Frequently Climbing: Occasionally Bending/Stooping: Frequently Kneeling: Occasionally Crouching/Crawling: Occasionally Reaching: Frequently Talking: Frequently Hearing: Frequently Repetitive Foot/Leg Movements: Rarely Repetitive Hand/Arm Movements: Frequently Keyboard Data Entry: Frequently Running: Occasionally Vision: Depth Perception: Frequently Vision: Distinguish Color: Frequently Vision: Seeing Far: Frequently Vision: Seeing Near: Frequently Owensboro Health Core Commitments INTEGRITY - We conduct ourselves with a high level of responsibility, reliability and honesty because we take seriously the trust of our patients and coworkers. RESPECT - We value and accept the unique talents and contributions of every patient, customer and team member in the Owensboro Health community. TEAMWORK - We build a spirit of connectivity and fellowship by striving together to overcome obstacles, surpass goals, celebrate accomplishments and plan the future. INNOVATION - We foster original ideas and creative solutions that improve our daily work and promote the mission of Owensboro Health. SERVICE - We focus on service to patients, customers and team members by anticipating their needs, thoughtfully meeting those needs and continually improving the quality of everything we do. EXCELLENCE - We reach beyond basic expectations to expand our knowledge and awareness, produce exceptional work and provide outstanding service.