Promotes quality patient care and outcomes by appropriate utilization of clinical resources and facilitates expected outcomes and promotes collaborative practices ensuring coordinated care, continuity and cost-effective patient care.
Consistently completes Admission Review Worksheet within 24 hours of a patient admission and certifies admissions according to the following: consistently ensures InterQual criteria is utilized, performs intensity of service review to ensure cost effective, medically appropriate utilization of services, performs severity of illness review to ensure patient is appropriate for admission and for unit admitted to, consistently screens for any post-hospital needs and makes timely recommendations and referrals as needed, ensures that documentation in patient chart is complete and accurate
Performs continued stay review every 48 hours until discharge using same criteria as established for initial admission review. Exhibits knowledge and good judgment in adjusting the frequency of review depending upon patient condition and circumstances.
Conducts concurrent reviews and initiates physician queries of records when clinical clarity is lacking in order to assist in accurately capturing the severity of illness, intensity of service and specificity of care rendered to patients.
Initiates queries, logs response to queries and assertively follows up on MD response to queries on a daily basis via face-to-face, written and/or other educational and communication venues to assure severity of illness, intensity of service and resource utilization are accurately reflected in the patient record and by DRG assignment.
Functions as an effective liaison between physicians, case management, health information management, clinical and administrative team regarding documentation integrity, issues and updates.
Exhibits skill and tact in working with physicians to coordinate the quality of patient care and appropriate use of resources with the appropriate length of stay. Engages physicians in the case management and discharge planning process through sharing of information, research, patient benefit information, post-hospital care options, etc.
Graduate from approved school of nursing, with a current Arkansas RN license.
At least 3-5 years nursing experience which includes critical care and two (2) years of coding, process improvement or utilization review. Comprehensive knowledge of general nursing, functions of hospital departments, JCAHO, federal and state regulations.
Demonstrated ability to function as effective team member with strong written and