ChristianaCare , a Magnet(r) health care organization with over 1,100 beds between its two hospitals (Christiana Hospital & Wilmington Hospital) and the only Level I trauma service on the East Coast corridor between Philadelphia & Baltimore, has been honored repeatedly as "One of America's Best Hospitals" by U.S. News & World Report. ChristianaCare is always seeking like-minded professionals to join us in our commitment to providing the best patient care in the region, and has just named 3rd in the Top 10 Best Hospitals to work for in the North East.
The Christiana Care Health System is currently recruiting multiple Full Time Registered Nurses to join the Utilization Management Team at the Christiana Hospital. We are recruiting full-time, Emergency Department based RN's for various shifts; weekend rotation. required - anticipated to be 1 out of 3 or four, No holidays. Available schedules are straight day, straight evening, and straight overnight.
We are seeking energetic, motivated RN's that want professional autonomy and understand the importance of care coordination. The Utilization Manager is a vital member of the interdisciplinary team that is responsible for the concurrent review of observation and inpatient medical records, coordinates care transitions with the patient care team to monitor length of stay, and facilitates accurate clinical documentation to support admission and medical necessity
We are seeking an energetic, motivated RN that wants professional autonomy and understand the importance of care coordination. The Utilization Review Nurse is a vital member of the interdisciplinary team that is responsible to create, implement, and monitor treatment plans to ensure safe, timely, and effective transitions throughout the care continuum and discharge planning.
Scheduled hours are days and evenings
Generous Paid Time Off, Competitive Pay & Robust Benefits Package
Highly engaged and motivated team
24/7 Leadership Support
Responsible to ensure that health care services are administered with quality, cost efficiency, and within compliance, along with improving and ensuring the overall quality, cost efficiency and completeness of documentation within the inpatient medical record. Continuously reviewing and auditing patient medical records (observation and inpatients), screening for unnecessary procedures, ineffective treatments, and unnecessarily extensive hospital stays. Educates members of the patient care team on documentation guidelines on an ongoing basis. Facilitates modifications to clinical documentation through extensive concurrent interaction with physicians, coding staff and other members of the healthcare team to support the appropriate reimbursement and clinical severity are captured compliantly for the level of service rendered to all patients.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
Concurrent review of observation and inpatient medical records throughout the patient's hospitalization.
Analyzes clinical status of patient (Observation v. Inpatient), current treatment, past medical history and identifies potential gaps in physician documentation.
Communicates with physicians or other providers to validate admission status and appropriately prompts for documentation if necessary, either verbally or written; educates these same individuals to improve documentation.
Ensures Medicare compliance via utilization management
Demonstrates proficient knowledge of HIMS standards of coding and applies to ongoing evaluation of the medical record documentation.
Reviews and clarifies clinical issues in the health record with the coding professionals that would support an accurate DRG assignment, severity of illness, and/or risk of mortality.
Monitors patients progress; consults with primary physician or designee and other members of the care delivery team at agreed-upon intervals, or more frequently, as needed.
Attends coding/financial/utilization management educational programs and regulatory educational programs and updates as necessary to maintain proficient knowledge base.
EDUCATION AND EXPERIENCE REQUIREMENTS:
Bachelor's Degree in Nursing
Registered RN licensed to practice in the State of DE required
Minimum of 3 years recent experience as a Registered Nurse in acute care, adult care setting,
Clinical Documentation, Performance Improvement, Case Management or Utilization Management experience desirable.
Internal Number: JR56977
About ChristianaCare Health System
ChristianaCare Health System is headquartered in Wilmington, Delaware and is one of the country's largest health care providers, ranking 21st in the nation for hospital admissions. Christiana Care is proudly a Nurse Magnet recognized institution. Christiana Care Health System is also one of the largest health care providers in the mid-Atlantic region, serving all of Delaware and portions of seven counties bordering the state in Pennsylvania, Maryland and New Jersey. A not-for-profit, non-sectarian health system, Christiana Care includes two hospitals with more than 1,100 patient beds, and is a major teaching hospital with two campuses. Christiana Care is continually recognized for excellence on a regional and national level. Our role in the community is expressed in the Christiana Care Way: "We serve our neighbors as respectful, expert, caring partners in their health. We do this by creating innovative, effective, affordable systems of care that our neighbors value."Christiana Care is a great place to work because we value diversity and recognize it to be a core part of our success. Because of the diversity of our employees, affiliated health professionals and volunteers, we are ...positioned to meet the unique needs of our patients and community. We acknowledge and celebrate the uniqueness and talent of each employee. Because of our talented workforce we are able to provide a quality healthcare experience to our patients and community. We strive to create an inclusive environment in which individual diversity can be leveraged and thrive. Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.