at Rush-Copley Medical Center in Aurora, Illinois, United States
Job Description
Position Summary
The registered nurse is responsible for the assessment, planning, implementation, and evaluation of the patients’ status, plan of care, and goal achievement. Utilizes the nursing process and approved criteria (as applicable) to determine appropriateness of admission and appropriate level of care for patients. Collaborates with physicians and staff to ensure patients are placed in the correct patient status. Communicates with payers regarding appropriate level of care, benefits, and financial resources available for patient care. Maintains documentation for insurance authorization, contacts, and records of transactions for each inpatient. Collaborates with the Patient Finance Department to ensure appropriate billing status. Care is provided in a compassionate, professional, ethical, and knowledgeable fashion based on the Caring Model, exemplifies the mission, vision and values of Rush Copley, and is in accordance with policies and procedures. The registered nurse is expected to uphold the most ethical and safe processes while keeping the care of the patient as a top priority. The position works closely with the entire multidisciplinary team and must have a complete understanding of own limitations and, in turn, seek advice, judgment and support of others, when necessary.
Critical Thinking
+ Utilizes evidence-based criteria to assess appropriateness of patient admission and level of care.
+ Provides continuous review of medical necessity. Notifies physician and collaborates with Physician Advisor Team when documentation indicates patient does not meet criteria. Responsible for documentation of appropriate patient status.
+ Assesses patients’ health care needs, monitors patients’ progress, and confers with care team regarding variances from the anticipated plan of care.
+ Provides basic assessment of patient’s previous level of function and identified discharge needs. Collaborates with Social Work counterpart for psychosocial and community based needs.
+ Manages a complex patient caseload and demonstrates expert ability to coordinate and implement discharge management services and provide continuity of care planning.
+ Efficiently and appropriately coordinates discharge planning for patients discharging to the community setting (i.e. home health, IV antibiotics, wound care).
+ Reviews admissions and ongoing stays of patients with respect to the medical necessity, appropriateness, and quality of care. Applies criteria, performs concurrent review process.
+ Works with providers and Physician Advisor Team regarding denials and appropriateness of appeal, if indicated.
Position Requirements :
+ Bachelor’s of Science in Nursing (BSN) preferred. For hires after 8/1/2013, must attain BSN within 5 years of hire.
+ Current state of IL Registered Nurse (RN) license required.
+ Strong leadership and role model skills to effectively assist unit staff and physicians in understanding managed care techniques and the value of changing practice patterns.
+ Effective analytical, organizational, written and verbal communication skills.
+ Knowledge of concepts and principles of Care Management and/or Utilization Review. Hospital experience preferred.
Rush is an equal opportunity employer. We evaluate qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status and other legally protected characteristics. If you are a qualified individual with a disability or a disabled veteran, you may request a reasonable accommodation if you are unable or limited in your ability to access job openings or apply for a job on this site as a result of your disability. You can request reasonable accommodations by contacting rush_recruitment@rush.edu.
