Division:Eskenazi Health
Sub-Division: Hospital
Req ID: 18831
Schedule: Full Time
Shift: Days
Eskenazi Health serves as the public hospital division of the Health & Hospital Corporation of Marion County. Physicians provide a comprehensive range of primary and specialty care services at the 327-bed hospital and outpatient facilities both on and off of the Eskenazi Health downtown campus as well as at 10 Eskenazi Health Center sites located throughout Indianapolis.
Job Role Summary
The Pre-certification Discharge RN works behind the scenes to maximize the quality and cost efficiency of health care services. Through partnership with utilization review team and inpatient case management team, the pre-certification discharge RN ensures that patients who are appropriate for post-acute care receive the care they need in a timely manner without burdening the health care system with unnecessary added days to their admission. This position is responsible for ensuring the provision of quality patient care, effective utilization of available health services, review of medical necessity for insurance precertification for discharge from Eskenzi Health to SAR/SNF facilities.
Essential Functions and Responsibilities
•Maximizes the quality and cost efficiency of health care services and expedites the precertification review process for patients who are appropriate for SAR/SNF.
•Communicates precertification patient status review decisions provided by secondary reviewer process
•Completes facility pre-certifications(SAR/SNF), removing facility precertification function from 3rd party rehabilitation facilities
•Coordinates with PT/OT/CM/SW/MD on facility placements and assist with timely clinical documentation
•Responsible for managing patient’s plan of care, monitoring for appropriate resource utilization, and collaborating with the inpatient team and outpatient providers to coordinate the patient’s transition plan of care.
•Patient advocate and primary nurse support, ensuring that quality and efficient care is provided through all aspects of utilization management across the continuum of care
•Assesses degree of medical necessity for patients seen in the acute inpatient space that requires post- acute care in SNF/SAR using the Eskenazi Health approved clinical decision support criteria.
•Reviews patients’ admissions for appropriateness and type. Refers case to Medical Director and/or Department leadership for review and course of action when case fails to meet admission standards
•Collaborates and communicates with Inpatient Case Management to ensure timely patient progression through the episode/plan of care
•Collaborates with department leadership, hospitalist, and surgeons to identify and discuss the most appropriate level of care
•Continually reassesses and monitors patients for change in condition altering plan of care, or change in care acuity reflecting appropriate utilization of resources
•Evaluates at appropriate intervals that the quality of healthcare provided to patients is delivered in an efficient manner throughout the patient’s episode of care
•Responsible for the SAR/SNF placement timeframe and continuums, they will manage the patient (in coordination with the treatment team) from time of SAR/SNF recommendation to DC ensuring that GMLOS will be met for all patients being placed in a post- acute rehabilitation facility.
•Communicates with the Inpatient Case Manager to ensure appropriate status and level of care for patient, and that transition plan is implemented with determined goals in mind.
•Collaborates with department leadership regarding coordination of care to optimize appropriate utilization of financial resources
•Evaluates the active funding for each patient and communicates with Inpatient Case Manager or Social Worker to facilitate initiation of appropriate funding applications.
•Ensures that the medical documentation supports the physician decision
•Ensures that transitions to post-acute services is appropriate and streamlined and durable medical equipment is appropriately utilized
•Ensures services not provided at Eskenazi Health is evaluated and appropriate authorization is given and documented
Job Requirements
- Current Indiana nursing license required
- Minimum of 4 years clinical nursing experience required
Knowledge, Skills & Abilities
• Must demonstrate knowledge of the Utilization Management managed care processes
• Competency in the following areas required:
o interpersonal, written/verbal communication, and negotiation skills
o diplomacy, flexibility, and professionalism
o cohesive networking with the Interdisciplinary Team
Accredited by The Joint Commission and named one of the nation’s 150 best places to work by Becker’s Hospital Review for four consecutive years and Forbes list of best places to work for women, and Forbes list of America’s best midsize employers’ Eskenazi Health’s programs have received national recognition while also offering new health care opportunities to the local community. As the sponsoring hospital for Indianapolis Emergency Medical Services, the city’s primary EMS provider, Eskenazi Health is also home to the first adult Level I trauma center in Indiana, the only verified adult burn center in Indiana, the first community mental health center in Indiana and the Eskenazi Health Center Primary Care – Center of Excellence in Women’s Health, just to name a few.