The Discharge Planner/Utilization Review RN conducts admission, concurrent
with retrospective utilization reviews for all assigned patients. This
individual communicates with payors, physicians and the Director of Nursing
to facilitate appropriate admissions and discharges, and to promote a
high quality of care while preventing under-utilization and over-utilization
of hospital resources. This person conducts discharge-planning activities
for assigned patients and completes data collection This person also is
responsible for an active utilization review of all patient admissions
and discharges, collaborates and facilitates on all Swing Bed admissions,
maintains an active re-admission review program, and works closely with
the Director of Nursing and the Nursing Leadership team to improve patient outcomes.
ESSENTIAL FUNCTIONS, DUTIES, AND RESPONSIBILITIES:
- Assesses patient’s needs and options for discharge planning. Interviews
patient and family to determine medical social needs and identify available
- Implements a discharge plan in conjunction with the patient and family
to assist in achieving optimal resolution of needs and problems.
- Promotes participation of the patient and family in development of the
- Maintains communication with a multi-disciplinary team related to discharge planning.
- Coordinates appropriate referrals and maintain relationship with referral/community services.
- Assist in placement of patients in a skilled nursing facility, rehabilitation
center, or hospital providing special services.
- Conducts chart review to analyze clinical data and record and submit to
regulatory agencies, PIN.
- Reviews medical records concurrently for medical necessity, intensity of
service, and continued stay review.
- Works with the Clinical Resource Nursing, Staff Development RN, and Nurse
Managers to ensure optimal outcomes on all patient admissions and discharges.
- Works in conjunction with medical staff on appropriate discharge planning
and admission status, educating physicians when appropriate
- Conducts regularly scheduled utilization review meetings, maintaining agendas
and notes, identifying opportunities for improved revenue opportunities.
- Conducts monthly re-admission analysis and chart reviews, reporting to
the Director of Nursing and an established re-admission work group on
opportunities for improvement.
- Works with Nursing Leadership on quality improvement programs and patient
satisfaction improvement projects.
- Insures over-all compliance with CMS standards for Discharge Planning and
- Attends meetings of staff, medical staff, and board as required.
- Other duties as assigned.
- Advises the Director of Nursing on discharge planning and utilization review.
- Maintains current understanding of changing utilization review requirements
- Develops networking opportunities for patient growth within the industry.
- Works in conjunction with all QI/PI projects.
OTHER FUNCTIONS, DUTIES AND RESPONSIBILITIES OF ALL EMPLOYEES:
- Supports and models individual behavior consistent with the Standards of
Excellence and the mission, vision and values of Livingston HealthCare.
Demonstrates commitment to customer service by:
- Building effective working relationships and treating others with respect
- Interacting with customers (Patients, co-workers and visitors) in a warm
and friendly way.
- Taking immediate action to meet customers’ needs or requests.
- Attentive to each customer concern.
- Demonstrates and encourages an ethic of open and effective communication
and teamwork throughout the organization
- Adheres to Livingston HealthCare’s Code of Conduct and Livingston
HealthCare and departmental compliance policies.
The above statements reflect the general duties considered necessary to
describe the principal functions of the job as identified and shall not
be considered as a detailed description of all the work requirements which
may be inherent in the position.