FUNCTIONS OF POSITION:
1. Performs admission, concurrent and focused reviews using severity of illness/intensity of service criteria to ensure effective utilization management.
2. Refers unjustified cases to physician advisor following hospital U.R. plan.
3. Collects and analyzes data to assure that quality and cost effectiveness issues are addressed for enhancement of patient care and Q.I./R.M./U.R. activities.
4. Maintains daily and monthly work log and/or abstracts on all reviews to ensure appropriateness of utilization review activities.
5. Prepares reports, graphs, and statistical data for reporting thru committee structures.
6. Collaborates with physicians, nurses, and other health care personnel to ensure effective utilization management.
7. Communicates with state PRO, insurance companies and other third party organizations to ensure appropriate utilization of resources.
QUALIFICATIONS:
EDUCATION: Graduate of accredited ADN or BSN program.
LICENSE: Possess current license by Missouri State Board of Nursing.
CREDENTIALS: Registered Nurse.
EXPERIENCE: Experience in case management preferred or two (2) years clinical experience in related field preferred.
SPECIAL:
PATIENT CONTACT: Must have the knowledge and skills necessary to provide care appropriate to the age of the patients served.
TYPING: Minimal
MACHINE OPERATION: Computer for entry or retrieval of data, 10 key calculator, copy machine, typewriter.
PHYSICAL:
STANDING: Minimal periods, but must be able to sit for long periods of time for reviewing of charts.
WALKING: Must be able to walk quickly to all areas of the hospital and occasionally to physician offices
LIFTING: Minimal - light loads (no more than 15 lbs)
VISUAL: Must have good acuity to review medical records, occurrence forms, computer screens, manuals, and other tools used in job performance
HEARING: Audio reception essential for effective understanding and communication with hospital staff and outside agencies
SPEAKING: Must have the ability to orally speak for effective communication with hospital staff and outside agencies
Weekdays
Skills Required
- Graduate of accredited ADN or BSN program
- Current license by Missouri State Board of Nursing
- Registered Nurse credential
- Experience in case management or two years clinical experience in related field
- Knowledge and skills to provide care appropriate to patient age groups
- Ability to operate computer systems for data entry/retrieval, 10-key calculator, copy machine, typewriter
- Ability to sit for long periods, walk quickly within hospital, and lift up to 15 lbs
- Good visual acuity, hearing, and verbal communication skills
What We Do
Missouri Delta Medical Center has been providing comprehensive medical care to the people of Southeast Missouri since 1948. Our doctors specialize in a wide range of medical services, and our staff focuses on offering personlized, compassionate care to you and your family. At our facility, you can find a wide array of medical professionals ranging for family doctors to internists to specialty surgeons. We understand that everyone's medical needs are different, and that these needs change as we age. That's why we work hard to maintain a highly assertive and talented staff that can quickly and effectively provide you with exactly what you need. Good health care begins on day one. If you are searching for the perfect Gynecologist or Pediatrician, take a look through our online list of physicians. Missouri Delta Medical Center is proud to have over 84 physicians on medical staff in over 25 different areas of healthcare, to ensure you find the perfect match. For some, the main hospital in Sikeston is a little far from home. Missouri Delta Medical Center includes several walk-in clinics around Southeast Missouri, all of which are equipped to handle an array of illnesses and injuries. Around the clock urgent care is always available at our main campus emergency room. We also have Express Care for less urgent, though immediate health concerns. Come to Missouri Delta Medical Center for the best orthopaedic surgeons, radiology, labor and delivery, and inpatient rehab in Sikeston.
