• Personal Effectiveness - Meets established timelines; follows through to ensure completion of assigned objectives, seeks feedback to improve performance, and demonstrates a positive, “can do” attitude
• Innovation and change - Looks for opportunities to improve processes and services, makes an effort to learn and develop new skills, and is resourceful and enthusiastic in responding to new challenges
• Fostering Teamwork - Is open and honest in dealing with others, demonstrates commitment to team objectives, and sees challenges facing department and helps the team to address them
• Quality Services - Delivers high quality services to internal and external customers, accepts responsibility and takes action to address quality issues, and helps operations & services respond to the needs of caregivers
• Integrity - Adheres to a standard of ethical conduct that promotes trust and open communication, earns trust by living up to commitments, and can be counted on to keep confidences

• Obtains appropriate authorization for admission and continued stay reviews from patient care payers and communicates the results to the appropriate PFS department and the clinical case manager who communicates to the attending physician.
• Works collaboratively with attending physicians and other interdisciplinary team members in planning quality care for positive outcomes.
• Audits the electronic medical record as requested by the patient, financial departments and outside auditing companies.
• Reviews patient’s plan of care for utilization appropriateness
• Acts as a liaison to facilitate transfer to the appropriate level of care by communicating with payor and facility RN Case Manager or Social Work Case Manager
• Reviews the Case Management Review Work queue – 0-2 day stays excluding Mother/Baby and Observation Cases to validate observation hours and carve-outs.
• Reviews the WQ for missing hourly and daily chargesUtilizes Inpatient Medical Necessity Screening Criteria on all observation cases. Collects, maintains and compares hospital and physician practice information to clinical protocols, length of stay criteria and other benchmarks established by the hospital.
• Reviews the observation patients and bedded outpatients and communicates with MD if patient is appropriate to transition to inpatient if discharge is not expected after 1 MN in the hospital.
• Monitors the documentation by Facility Case Management staff to communicate DCP to payor.

Skill and Attributes:

• Experience with patient safety best practices preferred.
• Demonstrated excellent customer service skills.
• Ability to maintain confidentiality regarding sensitive information
• Demonstrated proficient communication skills.

• Completion of education to obtain Texas Licensure as a Registered Nurse (RN)
• RN with 2-3 years of Clinical experience in the acute care setting

• Registered Nurse (RN) with Texas Board of Nursing – OR – current home state license is required for multi-state license recognition through the Nurse Licensure Compact
• Required to complete the education necessary to obtain my BSN degree within four (4) years of my date of hire
• BLS, ACLS and PALS through American Heart Association (AHA) required upon hire