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Inpatient Nurse Supervisor

Supervises inpatient case management operations to ensure evaluation of medical necessity for inpatient hospitalization using appropriate application of criteria.: Coordinates activities related to inpatient admissions, ongoing concurrent review, discharge planning, processing of reviews and serving as a clinical resource. Monitors activities to ensure that daily requests for inpatient authorization are processed within appropriate timeframes and according to department standards and plan agreements. Prepares and submits inpatient reports. Monitors departmental activities to ensure that the utilization management and case management programs are observed. Makes rounds in area hospitals to monitor inpatient services. Maintains an accurate census. Hires, develops and motivates a qualified department staff. This position typically requires a Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification. May perform routine internal monitoring of staff activities to ensure quality.

Inpatient Nurse

Works with health plan enrollees, providers and caregivers to provide intensive case management and increase efficient utilization of services. This position typically requires Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification.: Works with health plan enrollees, providers and caregivers to provide intensive case management and increase efficient utilization of services. Identifies and locates hospitalized patients requiring review for medical necessity to verify that hospitalization is necessary. Travels to local hospitals and offices to conduct rounds on patients. Identifies chronic cases through the concurrent review process and initiates intensive case management. Performs onsite reviews and evaluates the medical necessity for inpatient hospital admission. Authorizes the admission along with the estimated length of stay and level of service required. Coordinates services to be provided after inpatient hospitalization. Initiates and coordinates discharge planning on inpatient enrollees. Screens for the medical necessity of outpatient procedures, home medical equipment, medications and any other service that requires pre-certification as part of discharge planning. This position typically requires Registered Nurse license with direct patient care experience. May require a Certified Case Manager (CCM) certification. May perform utilization management activities to include pre-certifications, admission reviews, concurrent reviews and retrospective authorizations. May assist in medical protocols studies

Inpatient Nurse Case Manager

Coordinates the delivery of healthcare and social services to the inpatient population while balancing individually identified patient and family, medical, and psychosocial needs with cost-effective and available resources. Manages the inpatient hospital stay of a caseload of patients through coordination with physicians, social workers, nursing staff, and other health professionals. Reports to the Nurse Manager of assigned unit.: Performs utilization review and collaborates with the care team to formulate the discharge plan. Implements a plan of care utilizing approved clinical guidelines to transition and provide continuity of care for the patient to an appropriate lower level of care in collaboration with the hospitalist/physician member team, acute or skilled facility staff, ambulatory care team, and the patient and/or patient's representative from admission through discharge. Interfaces with physicians, nursing staff, and other members of the multidisciplinary and medical records coding staff to ensure appropriate reimbursement is received. Determines medical necessity for admission and continued stay according to specific criteria and regulations in accordance with the Utilization Review Plan. Conducts daily/concurrent reviews of charts to rectify any deviation from compliance. Educates staff, physicians, and other members of the multi-disciplinary team on documentation for compliance. Identifies consistent clinical and operational problem areas and facilitates resolutions through participation in the performance improvement process. Acts as liaison for the management and communication of information with the insurance/managed care companies of the assigned patient population.

Lactation RN

Develops, implements and educates patients, families, and staff on proper breast feeding techniques and lactation.: Provides consultation and instruction in basic breast feeding routines and techniques to new mothers, both inpatient and outpatient. Provides support and problem solving to patients experiencing feeding difficulty with infants. This position typically requires a valid license as a Registered Nurse and is typically certified by the International Board of Certified Lactation Consultants (IBCLC). Provides instruction, written information and demonstration of the use of various types of breast pumps and other devices. Schedules outpatient visits and provides consultation for breast feeding problems following discharge. Documents nursing interventions, patient response, effectiveness and complications. Prepares equipment and educates patient and family in proper use. Observes patient, records significant conditions and reactions, and notifies supervisor or physician of patient's condition and reaction to drugs, treatments, and significant incidents. Documents treatments and assessments in the patient’s medical record. May conduct breast-feeding education classes to the community.

Lactation Consultant RN

Critical Care Unit Nurse

Provides nursing care to Critical Care Unit patients in hospital or similar health care facility. Administers prescribed medications and treatments in accordance with approved nursing techniques. Prepares equipment and aids physician during treatments and examinations of patients. Requires RN license.: Observes patient, records significant conditions and reactions, and notifies supervisor or physician of patient's condition and reaction to drugs, treatments, and significant incidents. Takes temperature, pulse, blood pressure, and other vital signs to detect deviations from normal and assess condition of patient. Lends psychological and emotional support. Answers questions and concerns and provides information to patients and their family members regarding patients' care and treatment.

Resident Care Coordinator RN

Coordinates the work of all disciplines involved in completing Minimum Data Set (MDS) assessments and resident care plans according to regulatory requirements and guidelines. Provides assistance to the Nursing Director by providing in-service to staff, assessing competencies, and evaluating nursing staff. Plans, supervises, and evaluates the delivery of resident care and activities. Provides nursing care and ensures that nursing procedures are followed. Reviews resident care plans and conducts interdisciplinary care plan conferences. Typically requires completion of a nursing program at an accredited school of nursing as a Registered Nurse and a minimum of three years of nursing experience in a long-term care setting working with MDS. A valid nursing license is required.: Ensures that medical supplies and equipment are maintained on each unit. Oversees documentation to comply with Medicare or state reimbursement rules. Monitors medication passes and treatment schedules to ensure that they are properly administered. Interprets resident charts to accurately complete sections of the MDS. Performs quality improvement audits and assists in the implementation of quality assurance measures. Reviews resident charts for contradictions in information and researches any contradictions to determine what is valid. Reviews and investigates complaints and incident reports.

Call Center Nurse RN

Provides telephone triage to member of the health plan. Advises and instructs callers on proper health care after assessing the urgency of symptoms or complaints.: Answers telephone inquiries, assesses symptoms and provides assistance to members of the health plan in accordance with established policies, procedures and protocols. Provides clinical nursing evaluation and assessment and instructs callers to seek appropriate medical care. Notifies physician on call with pertinent medical information or if consultation is deemed necessary by nurse. Provides nursing referral to appropriate and available resources, including affiliated services, affiliated medical practice or community resource. Enters data into a computerized database and forwards facsimiles to appropriate health providers. Consults and facilitates after hours communication with physicians, nurses, hospital staff and outside agencies. Communicates with pharmacies and providers to refill medications or to clarify prescriptions. Typically requires graduation from an accredited School of Nursing as a Registered Nurse with two years of hospital or public health nursing experience. May provide health insurance eligibility, pharmacy benefits, provider information, and other information to callers.

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