Job Description

LOCATION:  WICKENBURG, AZ

 

Wickenburg Community Hospital is a beautiful and sophisticated rural-access hospital located in Wickenburg, Arizona.  WCH is a 8-bed Emergency Department, 19-bed Acute department and many ancillary services.  We also have 3 Primary Care Clinics.  Here at WCH, we strive to maintain the highest standards of professionalism and care.  Join us today and let us be part of your success story.

We offer:

  • Full Benefits
  • PTO/Sick Leave
  • Wellness Benefits

Wickenburg Community Hospital is a non-profit organization and qualifies for the Public Service Loan Forgiveness (PSLF) program.

General Description 

  • Advocates for patients and families and acts as a liaison with other team member to ensure that our patient’s healthcare needs are being addressed.
  • Collaborates with physicians and assists in referring healthcare resources to ensure services and care are delivered in a timely manner.
  • The RN Case Manager works in collaboration with patients, providers, and key individuals in coordinating a safe discharge.
  • Integral part of the interdisciplinary team and serves as the expert in case and utilization management.

Essential Job Duties 

Patient admission qualifiers:

  • Upon patient admission completes MCG Qualifier
  • Provides Physician education and assistance in the ED and for the Hospitalist to ensure appropriate admit status
  • Ensure MCG Qualifier is scanned into the chart.
  • Collaborates with Patient Access to provide a copy of the MCG Qualifier to be faxed to payers as indicated.

 SWING Bed Program:

  • Monitors network for potential SWING bed patients.
  • Works collaboratively with the WCH and sending facility to determine if the patient is an appropriate admit for the SWING bed program.
  • Complies information and completes communication dashboard regarding SWING bed progress.
  • Works collaboratively with the SWING bed team to review compliance and completeness of IDT documentation and required documentation. Effectively communicating to the team required needs to remain compliant with SWING.
  • Discharge planning to ensure the SWING bed resources are met.

Denials and Appeals:

  • Monitor every am and identify requests for clinical documentation from Insurance companies in Care Coordination email fax.
  • Identify denials and adverse decisions from Insurance companies in Care Coordination Fax email.
  • Assemble and fax requested documentation.
  • Submit any updated clinical documentation to insurance companies/VA, etc.
  • Determine need for Peer to Peer interviews; schedule Peer to Peer interviews; and advise leadership of outcome of Peer to Peer and any need for a formal appeal via email.

 Utilization Review Committee:

  • Run reports and extract data from EMR to review for UR monthly.
  • Collaborate with all departments of WCH to obtain department specific data and organize date for UR meeting.
  • Review CMS PEPPER Report to identify areas of concern and improvement
  • Update UR meeting Powerpoint with departmental data
  • Facilitate UR meetings quarterly, maintaining agenda and notes.

 General roles and responsibilities:

  • Rounds daily on Acute patients.
  • Assesses client needs upon intake to determine appropriate course of care.
  • Serves as a liaison between the patient and their family and the patient's network of care providers.
  • Educates patients on diagnosis, treatment options, and prognosis. Assists the patient in scheduling appointments, completing paperwork, or securing referrals.
  • Tracks and reports on patient progress. Actively participates in multidisciplinary huddles daily.
  • Identify and review all Observation patients approaching 48 hrs under Observation LOS.
  • Identify and complete 96+ hours under Inpatient LOS to be discussed in daily unit huddles.
  • Review with the Hospitalist to determine continued LOS; changing patient to Inpatient status vs discharge as indicated.
  • Performs work under minimal supervision. Handles complex issues and problems and refers only the most complex issues to higher-level staff.
  • Provide thorough care planning and coordination of all nursing and therapy staff in patient care. Assists with DME, home care providing contact information and support.
  • Ensures implementation of and compliance with company policies and procedures.
  • Analyzes medical records to determine legitimacy of admission, treatment, and length of stay in acute setting in accordance with patient needs, regulatory standards and insurance company guidelines.
  • Additional roles and responsibilities assigned per discretion of the Departmental Director as indicated.

Other (Non-Essential) Job Duties 

  • Participates in department meetings and assigned projects.
  • Is a key member of the WCH clinical team, offering mentoring and expertise as appropriate

Minimum Qualifications 

  • Current Arizona RN license
  • Associates degree in nursing
  • A minimum of 3 years of nursing experience.
  • Demonstrated oral and written communication skills, problem-solving skills.
  • An attention to detail and successful outcomes by stated deadlines is key.
  • Must have a track record of working closely with physicians and interdisciplinary team members; exhibit a service orientation.
  • Must have extensive background in working with insurance companies including Medicare and Medicare Advantage plans, AHCCCS, and Commercial plans

Preferred Qualifications 

  • Bachelor’s degree in nursing
  • 4+ years of nursing experience, with at least 1 year of Case Management experience.
  • Prior Utilization Review experience
  • Nursing/Certified Case Manager (CCM) is desired

Physical Requirements/Working Conditions

  • Frequent standing, stooping, bending, stretching, squatting; must be able to stand/walk for most of the work day.
  • Must be able to work paying close attention to detail with frequent interruptions.
  • Ability to work in a fast pace environment.
Apply Online