RN-Discharge Planner/Utilization Review, FT

Job Title:  RN - Discharge Planner/Utilization Review - Full Time

Reports To:  Director/Case Management 

Job Summary:   

The Discharge Planner/Utilization Review Coordinator is responsible for coordinating safe and appropriate discharge plans for patients, ensuring continuity of care across the healthcare continuum. This position also assists the case management department with utilization review activities, including sending timely clinical updates to insurance companies to support authorization for hospital services. The role requires strong organizational, communication, and collaboration skills to effectively work with patients, families, providers, payers, and community resources.

Demonstrates Competency in the Following Areas:

Discharge Planning

• Assess patients’ discharge needs early in hospitalization and throughout hospitalization.
• Collaborate with physicians, nurses, social workers, and other care team members to create individualized discharge plans.
• Coordinate post-acute services such as home health, rehabilitation, skilled nursing facility placement, or durable medical equipment.
• Provide patient and family education regarding discharge instructions, available resources, and follow-up care.
• Ensure all discharge arrangements are made in a timely manner to avoid delays in transition of care.
• Ability to communicate with physician regarding social service and discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.
• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.
• Ability to perform a head-to-toe assessment on all patients and reassessments as per policy. This includes pediatric, geriatric and the general patient population.
• Interacts professionally with patient/family and involves patient/family.
• Supports and maintains a culture of safety and quality.
• Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs.
• Communicates appropriately and clearly to Nurse Manager, co-workers and physicians.
• Maintains a good working relationship both within the department and with other departments.
• Documentation meets current standards and policies.
• Demonstrates an ability to be flexible, organized and function under stressful situations.

Utilization Review Support  

• Collect and review clinical documentation to support medical necessity for hospitalization.
• Send  timely clinical updates to insurance companies and payers to obtain continued stay authorizations.

Professional Requirements:

• Adheres to dress code, appearance is neat and clean.
• Completes annual education requirements.
• Maintains regulatory requirements.
• Maintains patient confidentiality at all times.
• Reports to work on time and as scheduled, completes work within designated time.
• Wears identification while on duty, uses computerized punch time system correctly.
• Completes in-services and returns in a timely fashion.
• Attends annual review and department in-services, as scheduled.
• Attends 12 staff meetings annually, or reads and returns all staff meeting minutes.
• Represents the organization in a positive and professional manner.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Complies with all organizational policies regarding ethical business practices.

Regulatory Requirements:

• Graduate of an accredited school of nursing.
• Current state Registered Nurse Licensure, within state of Arkansas.
• Current BLS certification.
• A minimum of five (5) years of experience in the acute care setting.

Language Skills:

• Able to communicate effectively in English, both verbally and in writing.
• Additional languages preferred.

Skills:

• Strong  assessment and critical thinking skill
• Knowledge of insurance processes, managed care, and medical necessity criteria
• Ability to work independently and as part of an interdisciplinary team
• Proficiency in EHR and Microsoft Office applications.

Physical Demands:

• Mobility, sight, hearing, verbal communication, changes in temperature, exposure to disagreeable elements, exposure to biological, mechanical, electrical, and chemical hazards. Frequent standing and walking. Lift up to 100 pounds. Carrying up to 40 pounds. Pushing/pulling up to 450 pounds.
• This position is a safety sensitive position pursuant to Amendment 98 to the Arkansas Constitution § 2(25). A safety sensitive position means any position in which a person performing the position while under the influence of marijuana may constitute a threat to health or safety. This position is therefore “safety sensitive” due to the fact it requires the following: performing life-threatening procedures; working with hazardous or flammable materials, controlled substances, food, or medicine; and a lapse of attention while working in this position could result in injury, illness, or death.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.