Registered Nurse (RN) - Case Manager - Transfer Center - PRN

Company: Avera Health
Location: Sioux Falls
Posted on: March 10, 2025

Job Description:

Registered Nurse (RN) - Case Manager - Transfer Center - PRN at Avera Health summary:
As a Registered Nurse Case Manager at Avera McKennan Hospital, you will review and analyze medical necessity criteria for patient transfers within the hospital system. This role involves coordinating communication between case managers, physicians, and patients to ensure proper care transitions and resource utilization. Additionally, you will facilitate discharge planning and collaborate with various departments to optimize patient outcomes.
Location:Avera McKennan HospitalWorker Type:PRNWork Shift:Day Shift (United States of America)Pay Range:The pay range for this position is listed below. Actual pay rate dependent upon experience.$30.50 - $45.75Position HighlightsDay shift as needed; PRNYou Belong at AveraBe part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.
A Brief Overview

Responsible for reviewing and analyzing information for medical necessity criteria for both internal and external transfers within the Avera system. Serves as a liaison for any communication between sending hospitals' case managers and providers and Avera Transfer Center RN and accepting physician. The Transfer Center Case Manager reviews patients for medical necessity, including both the level of care and the status, for any patient transferred into the hospital for acute care. This role will also utilize the EMR and patient flow software to ensure that patients are placed in the right bed at the right time, as well as assist with level-loading patients across the Avera system to ensure access to care for all Avera patients. The case manager facilitates the plan for an orderly transition of patients from the acute area setting to the next appropriate level of care. Works closely with physicians and payors to assure proper use of fiscal resources. Serves as liaison with physicians and staff to assure on going continuity.


What you will do

• Provides customer services in a manner consistent with principles of service excellence in order to achieve patient, family and physician satisfaction. Maintains collaborative relationships with providers, facilities and community agencies. Communicates in a respectful, courteous manner and assures that patients, families, and referral facilities receive thorough information.
  
• Verifies the appropriateness and necessity of admission to the acute hospital for all patients. Coordinates and communicates with all inter-disciplines to identify, plan for, and provide an appropriate follow up plan of care for all patients. Communicates this plan of care to patients, families, physicians, other hospital staff, communities, other agencies, and departments as necessary.
  
• Assists in meeting regulatory requirements for reimbursement from government and private payers. Maintains knowledge of services that are covered by managed care organizations and the government payers.
  
• Reviews all inbound and outbound transfers from Avera McKennan. Reviews appropriate cases for potential repatriation in an effort to ensure access to regional/tertiary level of care.
  
• Serves as system resource for Avera system Critical Access and PPS Hospitals for discharge and post-acute care planning and patient transportation needs. Completes PASSR forms for outbound transfers from Avera facilities as Swing Bed transfers.
  
• Supports compliance with Utilization Review Process. Case Manager will have ongoing conversation with Utilization Review staff on patients status and ongoing coverage
  
• Is a resource to patients, their families, and physicians as well as other disciplines, through all phases of hospitalization to ensure continuity and coordination of care. Uses nursing judgment and coordinates interdisciplinary team meetings in an effort to ensure ongoing assessment and care planning needs are met.
  
• Coordinates discharges for acute to acute transfers, home infusion, Durable Medical Equipment supplies, dialysis needs, and long term acute care facilities.
  
• Provides medical information (including updates) to facilities as requested during hospitalization and prior to discharge from facility to ensure continuity of care.
  
• Monitors documentation of patient care to assure appropriate evidence based plan of care in place throughout hospitalization.
  Essential Qualifications
  
  The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
  
  Required Education, License/Certification, or Work Experience:
  
  
  • Registered Nurse (RN) - Board of Nursing An active license in the state of practice Upon Hire
    Preferred Education, License/Certification, or Work Experience:
    
    
    • 4-6 years related experience and/or training
      Expectations and Standards
      
      
      • Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
        
      • Promote Avera's values of compassion, hospitality, and stewardship.
        
      • Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
        
      • Maintain confidentiality.
        
      • Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
        
      • Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.
        Avera is an Equal Opportunity/Affirmative Action Employer Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to talent@avera.org.
        
        Keywords:
        Registered Nurse, Case Manager, Patient Transfers, Healthcare, Medical Necessity, Utilization Review, Care Coordination, Patient Care, Avera McKennan Hospital, Transitional Care
        

Keywords: Avera Health, Sioux Falls , Registered Nurse (RN) - Case Manager - Transfer Center - PRN, Healthcare , Sioux Falls, South Dakota