1) Performs utilization review and discharge planning to inpatient admissions.
2) Applies Interqual, AEP and or other review criteria approved by the Clinic to accurately determine appropriateness for inpatient and outpatient care.
3) Utilizes clinical expertise to determine the appropriate level of care for patients. Leads the healthcare team in selecting appropriate, safe, hospital or alternative care options.
4) Works closely with Community Case Managers to collaborate regarding medically fragile and or high risk patients admitted to the clinic.
5) Identifies delay days and notifies Team Leader.
6) Reports serious occurrences and sentinel events to Risk Management.
7) Works with patients and families to facilitate post hospital care and develop plans to meet short and long-term needs.
8) Accurately manages observation status patients by working with physicians to ensure appropriate utilization.
9) Is part of the departments Saturday, Sunday, holiday and beeper rotation as needed.
10) Supports all service line activities related to utilization and quality management.
11) Assists in the development and implementation of clinical pathways.
12) Adheres to all insurance, contractual and regulatory requirements as mandated.
13) Works with Lahey Clinic nursing, social work and other members of the healthcare team to coordinate and facilitate patient discharge.
14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post acute care Services.
15) Participates in hospital or medical committees representing patient issues and department functions such as case management, utilization and CQI as requested.
16) Incorporates Lahey Clinic Guiding Principles , Mission Statement and Goals into daily activities.
17) Complies with all Lahey Clinic Policies.
18) Complies with behavioral expectations of the department and Lahey Clinic.
19) Maintains courteous and effective interactions with colleagues and patients.
20) Demonstrates an understanding of the job description, performance expectations, and competency assessment.
21) Demonstrates a commitment toward meeting and exceeding the needs of our customers and consistently adheres to Customer Service standards.
22) Participates in departmental and/or interdepartmental quality improvement activities.
23) Participates in and successfully completes Mandatory Education.
24) Performs all other duties as needed or directed to meet the needs of the department.
Licensure, Certification, Registration:
Must hold current Commonwealth of Massachusetts license as a Registered Nurse
Skills, Knowledge & Abilities:
In the absence of any of these skills, demonstrates the ability to be thoroughly trained to Proven leadership and project management experience and skill meet organizational standards.
Effective verbal communication, problem solving and conflict resolution skills.
Basic computer and typing skills.
Basic knowledge of Quality Improvement techniques.
Demonstrated ability to organize and work independently
A minimum of three years of medical/surgical nursing care experience. Two years of case management or utilization management experience desirable.
Demonstrated ability to communicate effectively with medical and hospital staffs.
DAYS, 20 hours
About Lahey Clinic
At Lahey Clinic, as one of the world's premier health care organizations, we provide superior health care leading to the best possible outcome for every patient. We exceed our patients' high expectations for service each day. We also help advance medicine through research and the education of tomorrow's health care leaders
We care for our patients with compassion and openness, unsurpassed expertise, a drive for continuous learning improvement, and with respect, caring, teamwork, excellence and commitment to doing our personal best.
Join our team and our mission of excellence by applying today!
How To Apply
Please apply directly online at http://www.lahey.org/careers. Use the Job ID number to quickly locate the appropriate job listing. Once you have located the desired job, click on the checkbox in the 'Select' column, and then click the 'Apply Now' button, located at the bottom of the screen. Please note you are only able to select 5 jobs at a time.
Lahey Colleagues please apply directly through Colleague Connection using your MR1 Login and Password.