Wilbarger General Hospital

Vernon, Texas

Job Description

Job Title:Case Management/Utilization Review Assistant

Department:Clinical Support Services

Job Summary:Assist with the Case Management/Utilization Review Program, including assisting the Case Manager with preauthorization of insurance, CMS reporting, admission and discharge documentation, insurance appeals and other duties as assigned. This position reports to the Utilization Review/Case Manager.

Job Qualifications:

A.Education:Graduate of accredited School of Vocational Nursing.

B.Personal Job-Related Skills:Basic understanding of medicine and disease processes as well as WGH functions. Effective oral and written communication skills including close interaction with physicians and other facilities. Basic computer, data collection, and information evaluation skills. Must be able to multitask effectively.

C.Licensure, Registry or Certification:Licensed Vocational Nurse currently licensed by the State of Texas Board of Nursing. BLS required; ACLS, and PALS required within 12 months of hire date.

  1. Experience:

1.Prior work experience:At least two years previous experience as a Licensed Vocational Nurse in a health care preferred.

E.Physical and Mental Requirements:Intermittent sitting, prolonged periods of standing and walking. Basically a sedentary position.

Essential Duties and Responsibilities:

  1. Assists with case management evaluations upon admission of the patient.
  2. Performs Insurance Preauthorization on each admission.
  3. Post discharge phone calls to be completed within 48 to 72 hours after discharge.
  4. Assists Case Manager with CMS reporting.
  5. Inputs swing bed orders once insurance approval is received.
  6. Processes Insurance appeals.
  7. Other duties as assigned.

Other Significant Requirements:

  1. Maintains confidentiality while working with confidential matters on a daily basis.
  1. Provides service direct to employees and/or patients while maintaining a positive employee and/or patient relations atmosphere.
  1. Interacts with patients, family members, Medical Staff members, department managers, and other staff on a continuous basis.
  1. Ensures that licensure and certifications are kept current and in accordance with state laws and hospital policy, and appropriate continuing education is attended for CEU requirements.
  1. Keeps current with new technology by attending educational offerings and literature reviews.
  1. Complies with accrediting agency recommendations.

STATEMENT OF UNDERSTANDING:

I have read and understand the above JOB DESCRIPTION and understand the essential duties outlined and required in this position. I understand that I should contact my Department Manager if I have any questions or concerns regarding the job duties and requirements as outlined above. I acknowledge that I have received a copy of this job description.

Employee SignatureDate

Department Manager SignatureDate

02/01/2018