Address
Form of work
SalaryStaff Nurse - Case Management
Per Diem - Days Variable
Skagit Valley Hospital
Job Summary
The position involves coordination of services to improve and maintain quality patient care and to ensure appropriate utilization of healthcare resources.
Serves as a liaison between the hospital, providers, and external payers on issues related to intensity of service and severity of illness for patients.
Ensures the timely and seamless transition of patients through medically appropriate levels of care.
Conducts patient status and medical necessity reviews at the time of hospital admission and also concurrently throughout the stay.
Reviews are documented in designated systems according to standard. In collaboration with physicians, promptly addresses documentation discrepancies. .
Essential Functions
Conducts and documents medical necessity reviews that demonstrate delivery of reasonable, necessary, and appropriate (according to evidence-based clinical standards of practice) patient care. Collaborates with contracted resources for external medical necessity reviews and audits. Documents Changes of Status (COS) and completes supporting paperwork. Performs readmission assessments utilizing indicated focus study. Assists with insurance requests for clinical reviews and continued stay authorizations.
Education
BSN required unless a Certified Case Manager (CCM), or 2 years equivalent experience.
Experience/Training
Minimum three (3) years clinical practice experience required. Previous utilization review experience strongly desired. Experience using medical necessity screening criteria preferred.
License/Certifications
Current Washington State RN License required. Certified Case Manager (CCM) or Certified Professional in Healthcare Management (CPHM) preferred.
Skagit Regional Health offers a comprehensive benefit package including medical, dental, vision, 457b/401a (retirement), long term disability, and paid time off to all employees holding an FTE of 20 or more hours per week. Eligible employees also receive sick time pay.
#INDRN
Pay: $35.82 - $66.24 per hour
Work setting:
- Acute care
Ability to Relocate:
- Mount Vernon, WA 98274: Relocate before starting work (Required)
Work Location: In person
