St. Anthony Summit Medical Center is a Level III Trauma Center serviced by Flight For Life® Colorado and nationally recognized for excellence in patient satisfaction. We provide a full range of medical specialties and health care services to Summit County and the surrounding areas including Surgical, Emergency, Critical Care, Birth Center, Orthopedic, Breast Care, Digital Mammography, Breast MRI, Radiology and Imaging, Nuclear Medicine, Cardiology, Summit Sleep Disorders Center, Ear Nose and Throat (ENT) and Summit Spine Services. Located in the charming mountain community of Frisco, CO, St. Anthony Summit Medical Center has provided 30+ years of service to residents and the visitors who enjoy spending time in these world famous outdoor playgrounds. In addition, Summit Medical Center employs seasonal professionals (Nov. to April) to support Colorado’s nearby ski resorts with on-site urgent care during the busy winter months. Enjoy an exceptional quality of life year-round with walking/bike trails right outside your door, arts and music festivals, and of course skiing, snowboarding and every winter activity imaginable. For more about Summit Medical Center and life in Frisco, CO please visit http://www.summitmedicalcenter.org.
Utilizes clinical expertise, discretion, and independent judgment in assessing/reassessing, facilitating care coordination, and patient advocacy. Responsible for assuring medical appropriateness criteria are met for status and level of care.
Minimum Education Requirements
Minimum Experience Requirements
1 year of nursing or case management experience.
Three years of recent acute care experience or case management experience, strongly preferred.
Experience in working with EMR. Working knowledge of regulatory requirements and accreditation standards, preferred.
Current RN License
Position Duties (essential functions denoted with an * )
Reviews & analyzes information relative to admission in accordance with Centura policy and documents assessment using case management software and/or other clinical information system.*
Assesses patient's physical, psychosocial, cultural and spiritual needs through observation, interview, review of records and interfacing with patient, physician and interdisciplinary team and caregivers to assist patient/family in making decisions toward next level of care.*
Facilitates discharge planning using case management software, working with patients, families and treatment team making any needed referrals/arrangements and documenting actions.*
Participates in the Performance Improvement process through concurrent chart review and participation on clinical effectiveness teams. *
Documents CM actions taken in EMR.*
Confirms treatment goals and anticipated plan of care through discussions with treatment team/review of documentation. *
Utilizes tools such as guidelines, criteria, or clinical pathways to assist in facilitating plan of care and appropriateness.*
Communicates treatment goals or best practices to treatment team including physician using established criteria/guidelines.*
Assess, coordinates and evaluates use of resources and services relative to plan of care and discusses variances on an as-needed basis with treatment team.*
Communicates modifications in plan of care to treatment team and any needs for further documentation.*
Facilitates family conference meetings on an as-needed basis and documents outcome.*
Participates and/or leads interdisciplinary rounds to facilitate plan of care and discharge.*
Reviews variance in Plan of Care with CM Director/Manager as needed.*
Interfaces closely with Social Worker, Homecare Coordinator, Ambulatory Care Case Manager, Disease Manager, and Utilization Reviewer to ensure seamless and timely delivery of services and avoid unnecessary delays in discharge.*
Maintains updated referral resource lists.*
Identifies when variances occur in anticipated plan of care, tracks for process improvement, and refers to CMO or PA or Third Party Reviewer for peer review as needed.*
Tracks avoidable days using case management software.*
Able to identify and apply evidence based criteria/regulatory guidelines for accuracy in establishing appropriate patient status and level of care. Applies medically necessary validation and may enlist physician advisor and/or Third Party Reviewer.*
Involved with identifying LOS and projected discharge date early in admission and communicate this to the care team.*
Works with third party payers to satisfy utilization review requests and obtain approval of stays.*
Participates in providing information on outliers for length of stay and recommending proactive solutions.* Participates in denial management with CM Manager/Director with clinical information for denial reversals.*
Performs utilization review in accordance with UM Plan to include concurrent/retro reviews and verify admission/bed status.*
Proactive management of factors influencing length of stay using critical thinking skills minimizing variance days.*
Proactive monitoring of appropriate patient status with interaction with physician for to assure correct order early in admission.*
* This job description is not intended to be an exhaustive list of all duties. Employee may perform other related duties as assigned.
☑ Medium Work - exert/lift up to 50 lbs. force occasionally, and/or up to 20 lbs. frequently, and/or up to 10 lbs. constantly
Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V.
Find your ideal career at Centura Health! With 16 hospitals, physician clinics, hospice services, home care and senior living communities, Centura Health's vast network of care spans Colorado and Western Kansas so you can experience a balanced lifestyle and enjoy a fulfilling career anywhere you want to work, live and play in Colorado. From the fast pace of a Denver-area Level 1 Trauma Center to a... smaller rural or mountain hospital – we proudly offer a more diverse range of work settings and locations than any other health care employer in the state. Centura is an equal opportunity employer.