Under the direction of the Inpatient Review Nurse Manager and Supervisor, the incumbent will work with their respective Team Centers, that may include a Concurrent Review Nurse and Inpatient Coordinator, along with hospitals and IPAs, to initiate coordinated and continuous cost- effective discharge planning to ensure the continuity Memberâs care needs are met timely and readmission prevention is anticipated for IEHP Members.
Major Functions (Duties and Responsibilities)
1. Responsible for assisting with data collection for utilization review, including, but not limited to Member specific needs for daily review in anticipation of discharge needs within 24 hours of admission.
2. Responsible for the arrangement of transitions to lower or higher level of care and assists with transfer orders as needed.
3. Responsible for authorizations for outpatient services or ancillary services in preparation for the Memberâs discharge including, but not limited to home care, home therapies and durable medical equipment.
4. Responsible for ensuring that discharge needs for Memberâs include referring Members to Health Management, Health Education, Care Management, Behavioral Health or other internal or external programs as needed.
5. Anticipates and acts upon barriers to ensure effective Member progression by identifying clinical, operational, financial, and social issues that may affect patient outcomes and provides recommendation to the Concurrent Review Nurse for collaboration in an effort to assist Members with adhering to treatment plans and goals.
6. Responsible for assisting Team Center with the identification of Members who are at risk for extended lengths of stay, readmission, high utilization and/or complex discharge needs within the LVN scope of practice. 5. Responsible for timely compliance and completion of cases as required by regulatory requirements. 6. Responsible for working with other Team Members, departments, IPAs and the facilities to support the goals of the department as well as strategic priorities and vision of the organization.
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