Continuously evaluates the quality, care, treatment and outcomes of complex patient populations. Collaborates with the patient/family and caregivers to facilitate necessary resources and options for post-discharge services to support a safe discharge. Provides consultation with physicians and other members of the interdisciplinary healthcare team to facilitate patient progression to discharge. Ensures clinical documentation supports medical necessity criteria and meets regulatory requirements. Communicates the clinical status of patients related to medical necessity criteria to the physician advisor (internal or external) and/or the Inpatient Care Transitions leadership team as needed. Monitors length of stay and documents avoidable days for delay of discharge. Reviews payer source for potential negative financial liabilities to the patient.
Must have a BSN from accredited program. Acceptable accrediting agencies are Commission on Collegiate Education in Nursing (CCNE), Accreditation Commission for Education in Nursing (ACEN) or Commission for Nursing Education Accreditation (CNEA).
Valid Indiana Registered Nurse license required. Certification in Case Management highly desirable.
Required at least 2 years of experience in acute care setting. Preferred experience in Case Management activities. Preferred experience or knowledge of InterQual criteria.