Performs admission reviews to determine medical necessity and appropriateness of admission based on approved criteria and standards. Codes diagnosis in accordance with International Classification of Diseases. Assigns initial length of stay in accordance with established norms. Collects and records all information necessary for admission and extended stay review.
Maintains system for monitoring all admissions and assures review of extended stay in a timely manner. Reviews all extended stays prior to expiration of initially assigned of stay. Refers questions of medical necessity or extended stay.
Interfaces with other hospital departments (normally including continuing care, social services, and fiscal) in matters of review decisions, discharge planning, social services, and fiscal communications.
Maintains established hospital policies, procedures, objectives, quality assurance, safety, environmental and infection control.
Attends required meetings and participates in committees as directed.
Maintains professional growth and development.
Performs admission, concurrent and focused reviews using Severity of Illness/Intensity of Service (SI/IS) criteria.
Maintains a computer or paper record of data obtained from admission, concurrent, and focused reviews.
Performs retrospective reviews or studies following designated guidelines, established by various clinical disciplines.
Consults with physician advisor regarding specific patients as required.
Maintains daily and monthly work logs of all admission, concurrent, focused, or retrospective reviews.
Assists utilization review committee and subcommittees in identifying areas of misutilization.
Prepares for on-site monitoring reviews by Blue Cross, Professional Standards Review Organization (PSRO) and various third party review organizations.
Current licensure with the AL State Board of Nursing as Registered Nurse. CPR certification.
2-3 years of experience in Case Management
About Highlands Medical Center
Highlands Medical Center in Scottsboro offer 21st Century healthcare to the people of Jackson County and surrounding areas. Skilled physicians and the dedicated team of medical professionals can take care of vast majority of healthcare needs. Our Medical Center offers a variety of service line expertise: Highlands Surgery Center, Imaging Center, Therapy Center, Sleep Disorders Center, Occupational Medicine Clinics, Urgent Care Clinic, Home Health and Two Health and Rehab facilities.