Department:OH1MH_62500_001 Social Services Mce
Expected Weekly Hours:40
Position Purpose:At Mount Carmel, we’re committed to making a meaningful difference in the lives of our patients and communities. Our colleagues – people like you – share our passion for always going above and beyond to provide the highest standards of care.
Job Description Details:
Our professional nurses are truly the heart and soul of Mount Carmel. It is their resilience, humility and determination that drive positive patient outcomes. To support you, Mount Carmel provides continuous opportunities for personal balance, professional opportunity and clinical growth. Our culture of shared governance and collaboration creates an environment that puts the focus on what’s truly important – our patients and the communities we serve.
Our RN Utilization Review Case Manager performs utilization review with payors, assists the physician with level of care determinations using screening criteria, assists the physician, bedside Registered Nurse, RN Case Manager and Social Worker with utilization management and clinical coordination of patients hospital stay. Complies with CMS rules and regulations and conditions of participation as well as commercial payer specific guidelines to prevent denials and revenue loss.
- Educates patient, families and other members of the care team about the financial out of pocket expense or financial responsibility of the patient. Assures all appropriate clinical information is provided to outside agencies.
- Communicates pertinent information to the appropriate members of the patient care team both effectively and professionally. Takes responsibility to identify and eliminate barriers to effective patient stay management and promotes improvements in work processes within department, hospital, and community.
- Provides consultation to professional staff and physicians on level of care determinations, CMS regulations and payer specific guidelines. Accurately and completely documents clinical reviews in accordance with documentation standards, policies, procedures and/or guidelines.
- Associates degree from an accredited RN program
- Current license to practice as registered nurse in the State of Ohio
- Minimum of 3-5 years recent clinical experience in an acute care setting, case management or utilization review experience.
Discovering opportunities, support and excellence – all while making a real difference in patients’ lives – begins at Mount Carmel. Find a new beginning and advance your career with us.
Mount Carmel and all its affiliates are proud to be equal opportunity employers. We do not discriminate on the basis of race, gender, religion, or physical ability.
Trinity Health's Commitment to Diversity and Inclusion
Trinity Health employs more than 120,000 colleagues at dozens of hospitals and hundreds of health centers in 21 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Trinity Health's dedication to diversity includes a unified workforce (through training and education, recruitment, retention and development), commitment and accountability, communication, community partnerships, and supplier diversity.