RN/LPN Utilization Review-BHU

Work Status Details: Full Time | 80.00 Hours Every Two WeeksExempt from Overtime: Non-ExemptShift Details: 8-5pDepartment: Behavioral Health Unit | Reports To: Director-Behavioral HealthThe mission of Faith Regional Health Services is to serve Christ by providing all people with exemplary medical services in an environment of love and care.Summary:The Utilization Review registered nurse performs utilization review and performance improvement functions as determined by supervisor. Analyzes patient records to determine legitimacy of admission, treatment and length of stay in health care facility to comply with government and insurance company reimbursement policies. Confers with medical and hospital personnel as well as payers to determine legitimacy of treatment and length of stay. Abstracts medical records for quality indicator information to aid in improving patient outcomes in conjunction with medical staff and other hospital personnel. Prepares correspondence and reports as needed. The nurse is a professional who is responsible for assessing, planning, implementing and evaluation patient care. The Utilization Review registered nurse must have the skills necessary to provide age-appropriate patient care and is accountable to the policies and procedures of the organization.The listing of job duties contained in this job description is not all inclusive. Duties may be added or subtracted at any time due to the needs of the organization.Responsibilities:Essential Job Duties and Responsibilities:1. Demonstrates ability to appropriately modify approach and procedures to meet needs of age/diversity of population served for the following age groups:☐ Neonate (birth - 28 days)☐ Infant (29 days - less than 1 year)☐ Pediatric/Child (1 year - 12 years)☐ Adolescent (12 years - 18 years)☒ Adult (18 years - 65 years)☒ Geriatric (over 65 years)Incorporates cultural considerations in the provisions of care.Knowledge of growth and developmental stages.Considers life changes/effects on health beliefs and behaviors.Provides necessary safety measures.Provides information and involves family/caregiver in decision making.2. Competent use of the nursing process to assess priorities, formulate, implement, evaluate and adapt the interdisciplinary plan of care to ensure quality of care is delivered.Verifies that patient face sheet is accurate and up to date.Identifies and documents patient's plan of care.3. Performs all responsibilities/duties required by the BHS department as defined in the scope of practice, to assure that the unique nature of the patient is addressed. This includes, but is not limited to the age of the patient served.Able to make decisions within the prescribed limits. Able to prioritize and coordinate duties as assigned.Demonstrates the knowledge and skills necessary to use a computer, proficiently to produce accurate letters, reports, agreements and other documents within requested time frames.Compose correspondence and schedules appropriate follow-up.Maintains accurate records and an organized, readily accessible filing system.Produces reports as requested.Maintains database as well as prepares reports as requested for FRHS and Region 4.Attends meetings as needed.Acts as a liaison with: FRHS Patient Financial Service, Region 4 and insurance providers.Supports and works effectively with multidisciplinary health care team. Demonstrates behaviors that promote positive customer relations with physicians, staff, patients and visitors.Responsible for maintaining a departmental climate of openness, fairness, acceptance of criticism and discussion of ideas within the department. Resolves conflicts both within and outside the department in an expeditious manner.Able to abstract patient charts for key quality indicators as determined by project leader or medical staff.Analyses insurance, governmental and accrediting agency standards to determine whether criteria are met concerning admission, treatments, and length of stay of patients.Reviews patient admission for appropriate criteria, contacts attending physician, or refers case to facility utilization review physician for review and course of action when case fails to meet admission standards.Competent use of the nursing process to assess, prioritize, formulate, implement, evaluate and adapt the plan of care to meet the patient's age-specific needs.Compares inpatient medical records to established criteria and confers with medical and nursing personnel and other professional staff to determine legitimacy of treatment and length of stay.Abstracts data from records and maintains statistics.Determines patient review dates according to established diagnostic criteria.May assist review committee in planning and holding federally mandated quality improvement review.When necessary, do retrospective reviews with the PRO and commercial insurance companies.Screens Medicare/Medicaid, Blue Cross/Blue Shield and other third party payer reviews on a pre-dismissal basis to identify potential quality issues and/or each extended stay determination, or other necessary correspondence. Assists the members of the medical staff with responding to PRO issues.Keeps abreast of current literature and outside agency requirements.Prepares agenda and other materials for utilization review meetings.Seeks the assistance of nursing service and other staff in the performance of UR/DRG related tasks.Offers education and information needed to keep the hospital staff and physician office staff current concerning rules and regulations generated by PRO and other review agencies.Participates in review of the UR plan on a yearly basis, and the UR Committee for assistance if an update is needed.Demonstrates clear, concise communications about patient care to members of the health care team and other professional and support staff in order to achieve positive patient outcomes.Maintain current professional credentials.Documents pertinent data based on the age, physical, psychosocial and cultural needs of adults and geriatrics.Actively participates in quality/performance improvement efforts and uses information to further enhance the quality of patientDemonstrates practices to keep medical records information protected and confidential.Records information on the patient record in accordance with charting and regulatory guidelines.Able to effectively manage phone screenings for individuals and outside agencies regarding appropriate placement.4. Assumes all other duties and responsibilities as necessary.Demonstrates willingness to identify and/or assume activities relative to the developmental needs of the unit and the nursing departmentDemonstrates dependability/flexibility in meeting scheduling needs of the unit and hospital.Demonstrates willingness to float to other units as needed.Accepts assignment as a coach for new staff.Accepts responsibility for mentoring healthcare students.5. Promotes organizational mission, vision and values. Demonstrates respect and regard for dignity of all patients, families, visitors, and co-workers to ensure a professional, responsible and courteous environment. Maintains a high level of professional responsibility and performance outlined in Faith Regional Health Services Performance Standards. Promotes effective working relationships and works effectively as part of a department team (inter- and intradepartmental) to facilitate the department's/clinic's ability to meet its goals and objectives.6. Maintains current knowledge/certification/licensure per organization policy. Pursues professional growth and development.Practices within legal boundaries of nurse practice act and according to organization policy and procedures.Attends continuing education programs in order to maintain licensure. Attends organization sponsored training programs as required.Maintains certifications as determined by department/clinic policy.7. Functions as role model for current and new staff.Facilitates problem resolution among coworkers as observed by management and peers.Demonstrates a constructive approach during all interactions with coworkers and management toward the organization.Promotes the profession of healthcare workers in the community.Presents neat appearance in proper attire and identification as required by the position, department and the organization.Continuously displays a positive attitude within the department/clinic and across departmental lines to contribute to the overall customer service program.8. Completes all required safety training programs and can describe his or her responsibilities related to general safety, department/service safety, and specific job-related hazards.9. Understands and adheres to Faith Regional Health Services Corporate Compliance Plan, Personal Conduct Policy, Safe Environment policy, Grievance Process, Confidentiality, Safety & Security, Infection Control, HIPAA and other departmental and organizational policies, procedures and guidelines.10. Must be able to remain awake and alert during working hours. Physical presence at facility is required during scheduled working hours to perform job functions.11. Performs other duties as assigned.Hours will be dependent on patient census and workload. Ability and willingness to work a flexible schedule, to include after-hours and weekends as necessary.To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.Other information:Job Requirements:The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required.EDUCATION (Minimum Requirements for Position):Graduate of an accredited school of nursing requiredBachelor's Degree preferredCERTIFICATES, LICENSES, REGISTRATIONS:Current or temporary permit Registered Nurse (RN) or Licensed Practical Nurse (LPN) from State of Nebraska- requiredCrisis Intervention Program (CPI-Advanced) obtained within 6 months from date of hire- requiredEXPERIENCE:Previous clinical experience- preferredSkills/Knowledge Requirements:SKILLS (If Applicable):Language Skills - Ability to read, write, speak, and understand the English language- requiredOther Certifications/Requirements:Must be 21 years of age to apply- required