Care Management Nurse - ED/IP Team - Weekend Option 3

Job description

Weekend Option 3 - 50/52 weekends Day shift: 7am-7pm: Split weekends in the ED and IP Team General Summary: Performs a variety of duties and applies utilization and care management techniques to determine the most efficient use of resources to support the provision of appropriate, cost effective and quality health care. Works in a team type assignment or Care Coordination Team (CCT) Model (Care Manager and Social Worker teams are assigned to patients by physician practice) to address patient care transition needs. Provides leadership in the integration of utilization and care management principles throughout the hospital. Duties and Responsibilities: Essential Functions: - Performs initial reviews for medical necessity and appropriateness of setting for the assigned case load. - Conducts concurrent reviews to ensure medical necessity for continued hospitalization and initiates problem-solving techniques as needed to prevent over and/or under utilization. - Liaisons between third party payers and the treatment team regarding the identified treatment plan in accordance with contractual guidelines or System policy. - Assists the patient care team with the identification and coordinati...