Description

Join Our Team at New Bridge Medical Center!**We are dedicated to providing high-quality, compassionate care to our diverse community. As a leading healthcare provider, we offer a supportive and inclusive work environment. If you’re passionate about making a difference and thrive in a collaborative setting, New Bridge Medical Center is looking for a Clinical Doc Reviewer RN.

Job Duties

Applies InterQual Level of Care and/or Milliman criteria to all admissions to determine the appropriateness of admission and the level of care (e.g., critical care, observation).Works with admitting physician, the admitting department, and nursing personnel to ensure appropriate bed assignment for admitted and transferred patients.Collects and documents objective data from patient record to support admission or level of care decisions.Initiates a case management plan and discharge planning activities at time of the first admission review, and updates it based on patient’s progress and needs.In consultation with a patient’s physician, establishes a targeted discharge date at time of the admission review (This is also known as an estimated length of stay or ELOS). Documents and communicates this targeted discharge date to the patient’s family, nursing and the multidisciplinary team via established processes.Uses clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and discusses with attending physician. Refer appropriate cases to physician advisor for review, as appropriate.Understand third party payers and current BRMC contractual agreements. Completes and communicates admission and concurrent review information to 3rd party payors. Documentall payer contact and denial.Documents and transmits (through a defined process) appropriate patient-level information to other unit-based case managers and/or discharge planners to ensure timely and accurate continuation of case management services when patient is transferred within the hospital.Monitors daily progress, including vital signs, resolution of signs and symptoms related to a procedure, complications, medications, fluids, pain.Meets with family/patient and communicates plan of care at time of assessment, and as appropriate throughout admission. Documents interaction and plan of care in medical record.Initiates referrals to appropriate departments and services within and outside the hospital. Serves as a liaison between the hospital and other facilities, home health and community agencies, and makes arrangements as needed for equipment and other required items to Monitors patient’s progress against BRMC-approved medical necessity guidelines, and evidence-based pathways/protocols. Identifies variances from standards or guidelines of care, and actively engages physician for decision making and intervention. be available at the time of discharge.Collects variance and delay data at time of occurrence (e.g., avoidable days, delays) for use by the department and organization.Provides notice of termination of benefits (TOB) and level of care (LOC) changes to individual patients and/or representative and other applicable parties on a timely basis.Uses data and information on a daily basis to prioritize and drive work effort.Leads multi-disciplinary rounds on a daily basis. Works to ensure that all department are accountable in coordinating efforts to achieve timely and appropriate patient care.Assumes responsibility for continuing education/professional development related to area of practice. Obtains continuing education in relevant topics as necessary for professional growth.Participates in department and hospital Performance/Quality Improvement activities, as assigned.Keeps statistics and records as required.Assumes additional responsibilities as delegated by the Director of the Department.

Other Duties

Position Qualifications3-5 years of Utilization Review or Case Management experience preferred in acute care settings.Previous InterQual experience preferred. Behavior Health experience with knowledge of emergency room admission criteria. desirableMust have current experience in Behavioral Health with knowledge of emergency room admission criteria.Experience in a Long-Term Care setting and working knowledge of Medicare Skilled Nursing Program and Medicare requirements desirableExcellent verbal and written communication skills.Ability to lead multi-disciplinary planning and decision-making sessions.Critical thinking/problem solving skills.Expertise with medical and multi-disciplinary practices and/or standards of care for selected diagnosis or conditionsGood interpersonal skills. Speaks, reads and writes English to the extent required by the position.

EducationCurrent NJ licensure as RN required. BSN or Bachelor’s degree in related field preferred.Minimum 2 years general clinical hospital experience required.Certification in Case Management (CCM) preferred upon hire or to be obtained within one year of hire.

Job Setting/Physical DemandsQuality and Outcome Management offices and patient care areas throughout the hospital; contact with staff, patients, families.Frequently prolonged standing/walking.

We provide a comprehensive benefits package, including a competitive medical, dental, and vision plans. We prioritize work-life balance with a generous time off policy that includes ample vacation days, personal time, sick leave and nine paid holidays. Additionally, we are committed to the personal and professional growth of our employees, offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.

Qualifications

Education

Required

• Bachelors or better

Preferred

• Bachelors or better in Registered Nurse

Licenses & Certifications

Required

• Registered Nurse