The purpose of Minidoka Memorial Hospital is to provide and promote high-quality, compassionate, primary health care services and health education to residents of, and visitors to, the Mini-Cassia region. We provide excellent benefits and small town environment.

DEFINITION

Assesses, plans, implements and evaluates the needs of patients for discharge planning and utilization review. This includes those who may be uninsured or those that have Medicare, Medicaid, or any other insurance provider to cover their stay at various units. Discharge planning is coordinated with physicians, nursing, patient and significant others who have an ongoing caring relationship with the patient. Utilization review procedures include those stated for discharge planning in addition to knowledge of criteria for Medicare, Medicaid coverage and any other insurance coverage.

REPORTING RESPONSIBILITIES

The Utilization Review/Discharge Planner reports to the Chief Nursing Officer in coordination of Utilization review and Discharge Planning.

JOB ESSENTIALS

• Responsible for performing assessments on Medicare, Medicaid and high-risk patients to determine discharge planning needs, always documents assessments.

• Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.

• Supports and maintains a culture of safety and quality.

• Able to communicate with physician regarding discharge planning needs of the patient. Assists the physician to facilitate post-hospital care.

• Is knowledgeable of criteria for Medicare, Medicaid, and private insurance coverage.

• Is knowledgeable of CMS regulations and executes requirements set forth by CMS for discharge planning.

• Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed. Is able to obtain other resources as needed.

• Communicates daily with admissions staff regarding admissions and discharges to various units.

• Initiates ongoing communication with the patient and patient’s; family to assess discharge needs.

• Treats patients and families with respect and dignity.

• Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.

• Interacts professionally with patient/family and involves patient/family in the formation of the plan of care.

• Documents discharge planning in an ongoing manner.

• Is knowledgeable of patient’s financial status, diagnosis and discharge needs.

• Is responsible for home care needs being met by the time of discharge, with a goal of arrangements completed 24 hours prior to discharge when date of discharge is known.

• Acts on performance improvement issues identified during Quality meetings.

• Cooperates with Case Manager’s activities with insurance company, based on information received.

• Maintains and respects confidentiality of patient/physician/staff information

• Collaborates with the Business Office Manager and onsite eligibility worker, where patients require such assistance.

• Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance list of facilities.

• Actively participates in Utilization Review Committee, Quality, varying team meetings and other meetings as appropriate.

• Executes Peer Review (Provider Chart Review) internally and externally according policy and CMS regulations.

• Demonstrates an ability to be flexible, organized and function under stressful situations.

• Maintains a good working relationship both within the department and with other departments.

• Consults other departments as appropriate to collaborate on patient care and performance improvement activities.

• Documentation meets current standards and policies.

• Evaluates patient care plans on a regular basis and updates the care plans when needed.

• Provides follow up phone calls on every discharged patient within 72 hours of discharge to ensure plan of discharge is appropriate and patient’s needs are being met.

Minimum Requirements

• Current Registered Nurse licensure in State of Idaho.
• Working knowledge of criteria for Medicare, Medicaid, and any other insurance coverage.
• Experience in providing patient care.

Preferred Requirements

• Bachelor's Degree in Nursing from an accredited institution.

Physical Requirements

• Carrying, Hearing/Listening, Lifting, Manual Dexterity, Pushing/Pulling, Seeing, Speaking, Standing, Walking.
• Physical and environmental requirement with or without reasonable accommodation