Rn Utilization Review - Patient Access

Penn State Health Corporation

Location : US:PA:Enola
Work Type : Full Time
FTE : 1.00
Shift : Varied
Hours : 9:30a - 6:00p Monday - Friday

** This is not a remote position- onsite working from the ED setting**

SUMMARY OF POSITION :
Performs systematic review of all observation, inpatient, outpatient surgery and swing bed patients in patient care area from (pre)admission through dismissal to assure the most efficient use of available health facilities and services while adhering to Federal and State requirements and guidelines.

ESSENTIAL DUTIES:

• Presents Hospital Issued Notices of Non-coverage to patient/family and attending physician when patient's stay will no longer be covered by Medicare.
• Interacts professionally with patient, family and other healthcare team members.
• Maintains a good working relationship both within the department and with other departments.
• Wears identification while on duty (including department keys).
• Documents in accordance with current standards/policies.
• Coordinates patient status information with other Hospital departments, physicians, physician's office staff, other acute care facilities and nursing facilities, as needed.
• Performs preadmission and continued stay preauthorization for patients identified by Admissions as required this service.
• Prepares and/or assists with maintenance of timely registries as required by Federal and/or State law.
• Prepares monthly reports for review by the Medical Staff.
• Reviews all preadmissions and admissions to observation and inpatient status within guidelines to assure criteria has been met for appropriate level of care.
• Reviews all admissions to the swing bed unit to assure placement in appropriate level of care. Updates and documents pertinent information regarding progress of the swing bed patient and assesses for continued appropriate level of care.
• Maintains confidentiality of all information received while performing job duties. Accesses Hospital computer system in accordance with Hospital and department policies. Attends appropriate Hospital in-services and other educational in-services as needed and requested to remain updated on Federal, State, Hospital and/or Department policies and procedures.
• Adheres to dress code; appearance is neat and clean.
• Demonstrates an ability to be flexible, organized and function under stressful situations.
• Adheres to Federal and State rules as outlined.
• Identifies preliminary (working) admission diagnosis to enable a tentative DRG and corresponding average length of stay to be assigned to each inpatient stay.
• Communicates with patients regarding their concerns, problems and/or understanding of their health insurance coverage. Contacts the Utilization Review Chairman concurrently regarding any patient not meeting continued stay criteria and/or meeting discharge criteria but not being discharged.
• Communicates with the Medical Staff and Nursing Staff any utilization issues concerning patient care activities.
• Prioritizes tasks and completes work in a timely fashion.
• Reviews all inpatient admissions concurrently (according to guidelines) until dismissal to assure continued stay and discharge criteria have been met. Communicates effectively with the attending physician any questions concerning patient status.
• Acts as liaison between Hospital, physicians, patients and Medicare/Medicaid/Insurance review staff.

MINIMUM QUALIFICATION(S):

Currently licensed to practice as a registered nurse by State of employment.

Minimum two (2) years experience in acute care hospital.

This job description is a general outline of duties performed and is not to be misconstrued as encompassing all duties performed within the position. All individuals (including current employees) selected for a position will undergo a background check appropriate for the position's responsibilities.

Penn State Health is fundamentally committed to the diversity of our faculty and staff. We believe diversity is unapologetically expressing itself through every person's perspectives and lived experiences. We are an equal opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to age, color, disability, gender identity or expression, marital status, national or ethnic origin, political affiliation, race, religion, sex (including pregnancy), sexual orientation, veteran status, and family medical or genetic information. If you are unable to use our online application process due to an impairment or disability, please call 717-531-8440 between the hours of 7:30 AM and 4:30 PM, Eastern Standard Time, Monday through Friday, email [email protected] or download our Accommodation Instructions for Job Applicants PDF for more detailed steps for assistance.