Posted Date: 2/24/2023
Job Location: St. Anthony Regional Hospital, 311 South Clark St, PO Box 628, Carroll, IA, 51401
Department: Quality Management
Employment Type: Full-Time
Job Description
SUMMARY
Performs as case manager and utilization review nurse regarding patient hospitalization. Reviews medical records to abstract data for performance improvement, utilization and risk functions.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
Reviews all Hospital admissions for medical necessity, continued stay, appropriate utilization of resources and timely documentation.
Relays patient information to insurance companies for certification and authorization of admission, pre-procedure review and continued stay review.
Abstracts the principal diagnosis and complications for timely review of utilization of resources based on the DRG.
Abstracts and applies statistical and informational data from the medical record, financial reports, variance reports and performance improvement activities to support the hospital-wide Performance Improvement Plan.
Maintains current knowledge of regulatory policies and applies this to the utilization review role in regard to admission and continued stay criteria.
Acts as a consultant and educator to performance improvement and patient safety project teams and to staff.
Abstracts quality improvement data for submission to appropriate quality and regulatory agencies.
Participates and assists with patient safety and quality improvement projects as required.
Completes all other duties as assigned.
Complies with the Corporate Compliance Policy and all laws, regulations, and Standards of Conduct relating to the position and agrees to report any suspected violations of law or Standards of Conduct.
Complies with all mandatory meetings and programs.
Maintains a safe work environment using safe work practices, utilizing standard precautions and complying with hazardous waste procedures at all times as described in St. Anthony's Safety Manual.
Maintains the confidentiality of patient, resident, employee and organizational information.
SUPERVISORY RESPONSIBILITIES
This job has no supervisory responsibilities.
QUALIFICATIONS
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
EDUCATION and/or EXPERIENCE
Graduate of an accredited school of nursing, BSN preferred.
LANGUAGE SKILLS
Ability to read, analyze and interpret technical journals, financial reports and legal documents. Ability to respond to common inquiries or complaints from customers, patients, families, regulatory agencies, or members of the community. Ability to effectively present information to management, the public and/or board of directors.
POSITION REQUIREMENTS, LICENSES, CERTIFICATIONS, REGISTRATIONS
Valid license to practice nursing in the State of Iowa.
CPHQ certification preferred.
PHYSICAL DEMANDS
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk and hear and use hands to finger, handle or feel. The employee frequently is required to sit and reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance; and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include close vision, depth perception, and ability to adjust focus.
WORK ENVIRONMENT
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually moderate.
Apply Online
If you have further questions, please call the Human Resources Department at 712-794-5111.
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