AZ - RN Case Management/Utilization Review
: Job Details :

Job Description:*******Fingerprinting must be submitted and cleared prior to start!***** **PLEASE SUBMIT CURRENT ADDRESS FOR FINGERPRINT PACKET TO BE MAILED VIA FEDERAL EXPRES** Please submit only if Tuba City housing and travel are secured. MUST provide copies of current immunizations, negative Tb skin test proof of last two years, provide documentation of 2 MMR vaccinations, Tdap, and Flu shot. Clean background check, negative 10 panel drug screen within 7 days, all PRIOR to arrival. Tuba City Regional Healthcare does not require your RN to have an AZ state license. Tuba City Regional Health Care Corporation, a JCAHO accredited health center, provides services to a 4,400 square mile area and serves as a referral center for the western part of the Navajo and Hopi Reservations. The hospital was constructed in 1975 with a bed capacity of 73. Services provided to the community include comprehensive inpatient/outpatient emergency services, dental and ophthalmology services, orthopedics, OB/GYN, oral surgery, eye surgery and urological procedures. Approximately 49% of the surgeries performed are out patient/ambulatory surgical procedures. Learn more about our organization. The Tuba City Regional Health Care Corporation is located in Northwestern Arizona on the land known as the Colorado Plateau. This semi-desert landscape varies in elevation from 4,400 in the Little Colorado River Valley to nearly 7,000 feet at Preston Mesa. The unique community of Tuba City offers a culturally rich environment. The Native American tribes located and served here are the Navajo, Hopi, and Southern Paiute. This mixture along with Anglo, Hispanic, and African American employees of the hospital and school systems make a pleasantly diverse community. The staff of medical providers includes surgeons, general medical officers, internal medicine, psychiatrists, pediatricians, family practice physicians, obstetricians, ENT specialists, orthopedic surgeons, and urologists. Dental staff includes general dentists, endodontists, oral and maxillofacial surgeons, pediatric dentists, dental assistants and hygienists. The nursing staff includes registered nurses, licensed practical nurses, nursing assistants, community health nurses, nurse practitioners, nurse midwives, CRNA, and community health medics.POSITION SUMMARYIncumbent serves as an Outpatient/Inpatient Case Manager/Utilization Review Registered Nurse (CM/UR RN) for TCRHCC and is responsible for direct supervision and supportive contact for the specific group of identified patient assignments and high-risk patients. The CM/UR RN is responsible for designing and managing a continuum of care focusing on empowering clients to achieve demonstrable outcomes and self-sufficiency. The CM/UR RN is responsible for assessment, service planning, and resource acquisition, monitoring progress and initiating and responding to emerging client needs. The CM/UR RN performs Utilization Review and Management/Clinical Documentation Chart Reviews of patients in the acute clinical care setting, ambulatory care setting and will conduct UR reviews as required. The CM/UR RN will work closely with the Social Work (MSW) Case Manager on Discharge Planning and Care Transitions. The CM/UR RN will work closely with the Physician Advisor and participate on the UR Committee as well as conduct Clinical Documentation Chart Reviews related to peer review, financial or insurance determination, or claims denials. The CM/UR RN will link the client with Community Social Service providers, health care providers, substance abuse, and mental health providers to achieve specific goals. The CM/UR RN will have experience working with culturally diverse low-income populations having multiple barriers to self-sufficiency such as: illiteracy, welfare dependency, domestic violence, substance abuse, and mental health issues. The CM/UR RN will work with a multidisciplinary team within the service delivery setting. The CM/UR RN will be committed to Case Management Services and have some collaboration with Purchased and Referred Care (PRC) formally known as Contract Health Services, providing assistance with the PRC Case Specialist. The CM/UR RN will be responsible to the Director of Care Coordination.NECESSARY QUALIFICATIONSEducation: Associates Degree in Nursing (ADN), must obtain bachelor s in nursing within two (2) years of hire License/Certification: Must have and maintain current Basic Life Support (BLS) certification by the American Heart Association (AHA) throughout employment A valid, current, full and unrestricted Professional Nursing License to practice as a Registered Nurse (RN) in any state of the United States of America, The Commonwealth of Puerto Rico, or a territory of the United StatesExperience: Three (3) years of clinical nursing experience performing direct patient care with at least 2 years in an Inpatient setting on a medical-surgical unit, PACU, or higher acuity Inpatient unit (ICU, Step-Down, Telemetry, etc.) or home health (direct care) {clinical experience qualification may be determined by hiring manager/director.} Demonstrate knowledge of the case management, purchased referred care and utilization review processes. Demonstrate knowledge of electronic health record systems.Position Urgency:NormalShifts:Monday to Friday, 8am-5pm Weekend on call rotation, would be 1 weekend a monthState License Details:Must Be Currently ActiveMinimum Years of Experience:3Minimum Guaranteed Hours:No GuaranteeSpecialty Type:NursingSub Specialty:Care Manager, Utilization Review RNGeneral Certifications:BLS/BCLSBilingual:NoEMR Used:AllscriptsHoliday Coverage Required:Yes