Location: GRMC-Silver City
Department: 8500 DISCHARGE PLANNING
The Case Management Registered Nurse who functions within accepted boundaries of nursing practice as defined by the New Mexico Nurse Practice Act and licensing requirements, Gila Regional Medical Center (GRMC) policies and procedures. She/he is responsible for assessing patient acuity status through concurrent review utilizing accepted criteria and collaborates with the medical and nursing staff to assure that patients are receiving services at the appropriate level of care within the institution. She/he is also responsible for recommending and/or facilitating the discharge planning process with patients, nursing, families, practitioners and outside agencies to assure that patient specific services are available. She/he communicates on a routine basis with various payors regarding the concurrent review status and discharge planning needs of affected patients within the institution. She/he completes appropriate documentation both internal and external necessary to document concurrent review and discharge planning activities. She/he takes into consideration the age of the patient at all times in assessing, planning and implementing patient care. Maintain current knowledge of Swing Bed regulatory requirements including, but not limited to, Critical Access Hospital Appendix W and the Medicare Benefits Manual Chapter 8.
Attends daily report, presents update concurrent review status and discharge planning status of assigned patients.
Functions in diversity of roles: Utilization Review & Discharge Planning.
Performs initial review utilizing MCG within 24 hours of admission.
Performs concurrent review and documentation.
Collaborates with attending physician and nursing staff regarding patients who do not meet acute stay criteria.
Leads collaborative efforts with interdisciplinary team to develop a discharge plan with the patient and or representative.
Communicates pertinent information for medical review and discharge planning purposes to payor per contractual agreements with GRMC.
Discusses and or refers financial issues with patient or patient financial counselors.
Enters observation days/charges.
Completes documentation in Meditech and MCG modules.
Delivers Medicare Important Messages, MOON Notice, and HINN letters per CMS guidelines.
Works with appropriate hospital and community resources to facilitate an optimal discharge plan.
Participates in duties as assigned to facilitate departmental workflow.
Participates in assurance of Quality and Core Measure accountability.
Review of charts for denial and appeal.
Participate in Utilization Review Committee.
Provide patient a choice of post-acute providers and document in the medical record.
Complete pre-admission screening and payor authorizations for both internal and external swing bed patients.
Provide patient with all required admission notices and disclosures, and document in medical record.
Coordinate and document IDT meetings.
Provide patient with all required discharge notices and disclosures, and document in the medical record.
Provide the next provider of care with all required discharge information to provide continuity of care.
Notify ombudsman of all discharges.
Current New Mexico or Multi-State RN Licensure
AHA – BLS
Five years experience as acute care RN preferred
Critical Access/Swing bed experience preferred
Prior experience in Case Management/Utilization Review preferred.
Certification on Case Management preferred.
Demonstrated knowledge and skills necessary to provide care appropriate to the age of the patients served within the Medical –Surgical Units.
Demonstrated proficiency in acute care nursing knowledge and skills.
NOTE: Job description available on request.
**All required documents must be presented at time of hire.**
EXTERNAL APPLICANT: Employment is contingent upon successful completion of pre-employment drug and alcohol testing.