Job Description

SUMMARY

The Transitional Care Utilization RN coordinates seamless patient transitions across the continuum of care, including review of admission for appropriate admission status for medical necessity, discharge, and facilitating communication between the hospital, LTC facilities, insurers and completing post-acute follow-up. This role promotes quality outcomes, reduces avoidable readmissions and promotes safe, efficient, and patient-centered care transitions.

DUTIES/RESPONSIBILITIES

(include but are not limited to the following)

Assists with application of approved UR criteria and organizational standards. This includes the review of inpatient and observation admissions to assess medical necessity, level of care, and continued stay appropriateness in accordance with CMS regulations, CAH requirements, and payer guidelines. Participates in (in-person) inpatient unit table rounds and daily care coordination discussions M-F. Ensures timely and accurate communication of patient information during hospitalization with LTC facilities. coordinates WCHC SNF referrals and collaborates with insurance payors as needed. Serves as liaison among hospital and clinics teams. Identifies patients eligible for TCM (Transitional Care Management) services based on CMS criteria

EDUCATION AND/OR EXPERIENCE

Current RN license in the State of Iowa. Minimum of two years clinical experience (acute care preferred). Experience in case management, discharge planning, or care coordination preferred. Familiarity with MCG/Milliman strongly preferred.

SKILLS AND ABILITIES

Strong communication and collaboration skills. Communicates admission status recommendations and continued stay findings to providers and leadership in a timely and professional manner Knowledge of clinical guidelines and UR tools such as MCG. Ability to work independently in a hybrid environment. Strong organizational and problem solving abilities. * Proficiency with EMR systems and care coordination workflows.