Per Diem / PRN Nurse RN - Case Management
North Mississippi Health Services
Tupelo, MS

**Review Activities:**

* monitors individual cases in relation to established criteria, LOS & patient care guidelines
* assures patient is meeting level of care criteria & issues denial of care letters as necessary
* intervenes as indicated to promote the timely provision of care & utilization of resources
* serves as a resource for physicians & nurses in understanding criteria for continued stay & medical necessity
* monitors patient outcomes to evaluate clinical & financial effectiveness
* reconciles services rendered with patient benefits & communicates with physicians & 3rd party payers to assure appropriate reimbursement


**Clinical Practice:**

* collaborates with patient care team to move population along the continuum by effectively planning for continued care as moving to another level of care to ensure all patient needs are addressed
* assesses social/emotional factors affecting health status of patients & makes appropriate referrals
* participates on Discharge Planning Team & initiates d/c planning early in the treatment process based on requirements of the plan of care & needs identified during initial assessment


**Swing Bed Responsibilities:**

* participate on  SWB Team and facilitates screening of patients for eligibility
* provides  SWB information to patients & families as appropriate
* monitors patient progress for timely discharge to the appropriate setting
* assists with  MDS as required for billing/reimbursement as needed


**Reports:**

* identifies & reports physicians practice patterns & resource utilization
* maintains accurate records of review & discharge planning activities
* trends & reports lack of medical necessity for admissions, observation vs admission appropriateness, and LOS


**Customer Service:**

* maintains constructive working relationships & communication with physicians, professional staff, and other members of the health care team regarding issues of continued stay & documentation of medical necessity
* collaborates with business office to ensure accurate billing and statistical information
* collaborates with social worker to identify & coordinate resources, internal and external, to best meet patient needs
* competent to communicate on all levels to assess discharge needs of all age groups of patients

participates in educational meetings with physicians office personnel as requested


Job Knowledge: 

* currently licensed in Alabama  as a Registered Nurse & in good standing with the State Board of Nursing
* minimum of 5 years of experience with a broad base of clinical expertise
* ability to read & interpret medical record documentation
* ability to operate a PC
* good organizational skills & high level of self-initiative
* effective verbal & written communication skills

maintains current ACLS and BLS certifications