Job Information
Bartlett Regional Hospital Registered Nurse Case Manager - Utilization Review (P/T) in Juneau, Alaska
This recruitment is open until filled.
Bartlett Regional Hospital is searching for aRN Case Managerto join our Case Management team!
This position is eligible for relocation assistance of up to $10,000 plus 30 days of housing. Contact Human Resources at 907-796-8418 for details.
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Job Summary: Under general direction of the Case Management Director, the RN Case Manager utilizes well-developed knowledge and skills in areas of utilization management, medical necessity, patient status determination, Medicare compliance, and revenue cycle; collaborates with the multidisciplinary patient care team for optimal patient care outcomes, discharge planning, and readmission prevention; and participates in ongoing assessment of systems and clinical care processes.
This position is assigned to the Case Management Department, which includes Nurse and Social Work Case Managers, as well as Clinical Documentation Integrity (CDI) specialists, who collaborate with nursing, physicians, and the interdisciplinary team to ensure that optimal, quality care is delivered in the most efficient and cost-effective manner by monitoring specific patient care needs and facilitating care coordination and resource referral to ensure effective outcomes.
What Will You be Doing: Utilization Review: Uses utilization management techniques to determine the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. Communicates this information with the interdisciplinary team to ensure compliance with regulatory requirements, policies and procedures, and quality patient care for the duration of the hospitalization. Responsible for timely regulatory compliance, including delivery and explanation of Medicare forms; submission of clinical reviews in compliance with requirements of a variety of payer types; and denial management. Actively participates in revenue cycle and clinical performance improvement activities.
Care Coordination: Participates with daily interdisciplinary treatment team rounds; Works collaboratively with SW case managers, the physicians, nursing and other members of the multi-disciplinary care team to effect timely and appropriate patient management along the continuum of care. Supports coordination of services and aftercare as needed.
Minimum Qualifications for the Job:
- Education:Graduation from an accredited School of Nursing. Bachelor's of Science in Nursing preferred.
- Experience:Three (3) years of acute care nursing experience.
- Preferred Experience:One (1) year experience in utilization review, case management, care coordination, quality management or similar role is preferred.
- License(s):Current State of Alaska Registered Nurse license.
- Certification(s):TEAM and BLS within three (3) months of appointment
Internal Hires:Pay rate will be determined based on applicable personnel rule or union contract terms.
Practice Notices:
- All new employees are required to produce negative drug screen prior to start of employment.
Bartlett Regional Hospital is an Equal Opportunity Employer and considers applicants for all positions without regard to race, religion, national origin, gender, age, disability, sexual orientation, marital status or any other legally protected status.