Job Description

Job Description

Havasu Regional Medical Center

Monitors and manages patient care to promote continuity of care, optimal patient outcomes, patient satisfaction, cost efficiency, and compliance.

Essential Functions

To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.
Effective, professional and concise communication with all services involved with the management of patients to establish a good working rapport. Ensures respect for patient/employee rights and promotes patient/employee advocacy.
Performs and documents admission and continued stay reviews on assigned patients including initial discharge assessment on first business day after admission and continued stay reviews every 72 hours during admission.
Reviews all new patients on assignment daily to determine if the correct admission status is ordered. Notifies physician immediately if status needs to be revisited and documents in the computer system. Notifies director if status could present as a denial.
Initiates and obtains all initial insurance authorizations daily during normal business hours. Must make the initial phone call to the UR department and fax all pertinent clinical to validate the admission. All subsequent documentation is placed the computer timely.
Working knowledge of Medicare, Medicaid, State, and Insurance regulations and guidelines that will dictate care during and post discharge of hospitalized patients.
Establishes, documents and facilitates a safe discharge plan for designated patients utilizing appropriate criteria and services available. Plans will be established proactively with patient, family, nurses, physicians and any outside sources to ensure timely discharges. insurance authorizations for all services will be obtained in a timely fashion.
Determines assigned patients designated length of stay and works proactively with all services including family, patients, physicians, nurses and ancillary services to ensure discharge in a timely manner.
Records avoidable days and LACE tools as needed daily on all assigned patients.
Initiates, collects and files all required forms for patient care and delivery including but not limited to Medicare IM letters, MOON observation letters, HINN letters and Choice letters.
Performs daily criteria reviews including Interqual and 5 elements on all new assigned patients. These are documented on CM UR worksheet and filed in the appropriate computer folder..
Attends all assigned meetings timely and is prepared for presentation as required.
Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or is a logical assignment to the position. This position description does not restrict the right of management to assign or reassign duties and responsibilities with and without notice.

Job Requirements

Minimum Education Required
Associates degree

Licensure(s) Required Upon Hire:

AZ registered Nurse or Compact State license

**Please note if working under Multi-State Compact License RN will have 30

days from date of hire to designate AZ as Home state with nursing board

Certification(s) Required within 30 days of hire:
Basic Life Support (BLS)

Required Skills
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

LifePoint Health is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans status or any other basis protected by applicable federal, state or local law.