Job Description
Review Activities:
Clinical Practice:
Swing Bed Responsibilities:
Reports:
Customer Service:
Job Knowledge:
- monitors individual cases in relation to established criteria, LOS & patient care guidelines
- assures patient is meeting level of care criteria & issues denial of care letters as necessary
- intervenes as indicated to promote the timely provision of care & utilization of resources
- serves as a resource for physicians & nurses in understanding criteria for continued stay & medical necessity
- monitors patient outcomes to evaluate clinical & financial effectiveness
- reconciles services rendered with patient benefits & communicates with physicians & 3 rd party payers to assure appropriate reimbursement
Clinical Practice:
- collaborates with patient care team to move population along the continuum by effectively planning for continued care as moving to another level of care to ensure all patient needs are addressed
- assesses social/emotional factors affecting health status of patients & makes appropriate referrals
- participates on Discharge Planning Team & initiates d/c planning early in the treatment process based on requirements of the plan of care & needs identified during initial assessment
Swing Bed Responsibilities:
- participate on SWB Team and facilitates screening of patients for eligibility
- provides SWB information to patients & families as appropriate
- monitors patient progress for timely discharge to the appropriate setting
- assists with MDS as required for billing/reimbursement as needed
Reports:
- identifies & reports physicians practice patterns & resource utilization
- maintains accurate records of review & discharge planning activities
- trends & reports lack of medical necessity for admissions, observation vs admission appropriateness, and LOS
Customer Service:
- maintains constructive working relationships & communication with physicians, professional staff, and other members of the health care team regarding issues of continued stay & documentation of medical necessity
- collaborates with business office to ensure accurate billing and statistical information
- collaborates with social worker to identify & coordinate resources, internal and external, to best meet patient needs
- competent to communicate on all levels to assess discharge needs of all age groups of patients
Job Knowledge:
- currently licensed in Alabama as a Registered Nurse & in good standing with the State Board of Nursing
- minimum of 5 years of experience with a broad base of clinical expertise
- ability to read & interpret medical record documentation
- ability to operate a PC
- good organizational skills & high level of self-initiative
- effective verbal & written communication skills
About North Mississippi Health Services
North Mississippi Health Services (NMHS) is a diversified regional health care organization serving 24 counties in north Mississippi and northwest Alabama and is one of the largest employers in Mississippi with over 6,900 employees. NMHS covers a broad range of acute diagnostic and therapeutic services offered through North Mississippi Medical Center (NMMC) in Tupelo, Community Hospital System, and North Mississippi Medical Clinics. NMHS strives to improve the health for people in this region by providing conveniently accessible and cost-effective healthcare of the highest quality.
