Clincial Documentation Reviewer Rn- Continuum Of Care Full-Time Flex 24813

Join Our Team at New Bridge Medical Center!**

We are dedicated to providing highquality compassionate care to our diverse community. As a leading healthcare provider we offer a supportive and inclusive work environment. If youre passionate about making a difference and thrive in a collaborative setting New Bridge Medical Center is looking for a Clinical Documentation Reviewer.

Job Duties

Applies Inter Qual Level of Care and/or Milliman criteria to all admissions to determine the appropriateness of admission and the level of care (e.g. critical care observation).
Works with admitting physician the admitting department and nursing personnel to ensure appropriate bed assignment for admitted and transferred patients.
Collects and documents objective data from patient record to support admission or level of care decisions.
Initiates a case management plan and discharge planning activities at time of the first admission review and updates it based on patients progress and needs.
In consultation with a patients physician establishes a targeted discharge date at time of the admission review (This is also known as an estimated length of stay or ELOS). Documents and communicates this targeted discharge date to the patients family nursing and the multidisciplinary team via established processes.
Uses clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and discusses with attending physician. Refer appropriate cases to physician advisor for review as appropriate.
Understand third party payers and current BRMC contractual agreements. Completes and communicates admission and concurrent review information to 3rd party payors. Document
all payer contact and denial.
Documents and transmits (through a defined process) appropriate patientlevel information to other unitbased case managers and/or discharge planners to ensure timely and accurate continuation of case management services when patient is transferred within the hospital.
Monitors daily progress including vital signs resolution of signs and symptoms related to a procedure complications medications fluids pain.
Meets with family/patient and communicates plan of care at time of assessment and as appropriate throughout admission. Documents interaction and plan of care in medical record.
Initiates referrals to appropriate departments and services within and outside the hospital. Serves as a liaison between the hospital and other facilities home health and community agencies and makes arrangements as needed for equipment and other required items to Monitors patients progress against BRMCapproved medical necessity guidelines and evidencebased pathways/protocols. Identifies variances from standards or guidelines of care and actively engages physician for decision making and intervention. be available at the time of discharge.
Collects variance and delay data at time of occurrence (e.g. avoidable days delays) for use by the department and organization.
Provides notice of termination of benefits (TOB) and level of care (LOC) changes to individual patients and/or representative and other applicable parties on a timely basis.
Uses data and information on a daily basis to prioritize and drive work effort.
Leads multidisciplinary rounds on a daily basis. Works to ensure that all department are accountable in coordinating efforts to achieve timely and appropriate patient care.
Assumes responsibility for continuing education/professional development related to area of practice. Obtains continuing education in relevant topics as necessary for professional growth.
Participates in department and hospital Performance/Quality Improvement activities as assigned.
Keeps statistics and records as required.
Assumes additional responsibilities as delegated by the Director of the Department.

Other Duties

Position Qualifications
35 years of Utilization Review or Case Management experience preferred in acute care settings.
Previous InterQual experience preferred. Behavior Health experience with knowledge of emergency room admission criteria. desirable
Must have current experience in Behavioral Health with knowledge of emergency room admission criteria.
Experience in a LongTerm Care setting and working knowledge of Medicare Skilled Nursing Program and Medicare requirements desirable
Excellent verbal and written communication skills.
Ability to lead multidisciplinary planning and decisionmaking sessions.
Critical thinking/problem solving skills.
Expertise with medical and multidisciplinary practices and/or standards of care for selected diagnosis or conditions
Good interpersonal skills. Speaks reads and writes English to the extent required by the position.

Education
Current NJ licensure as RN required. BSN or Bachelors degree in related field preferred.
Minimum 2 years general clinical hospital experience required.
Certification in Case Management (CCM) preferred upon hire or to be obtained within one year of hire.

Job Setting/Physical Demands
Quality and Outcome Management offices and patient care areas throughout the hospital; contact with staff patients families.
Frequently prolonged standing/walking.

We provide a comprehensive benefits package including a competitive medical dental and vision plans. We prioritize worklife balance with a generous time off policy that includes ample vacation days personal time sick leave and nine paid holidays. Additionally we are committed to the personal and professional growth of our employees offering robust tuition reimbursement and continuing education programs to help support our employees ongoing development.