Discharge Planner/UR RN

Utilization Review · Portales, New Mexico
Department Utilization Review
Employment Type Full-Time
Minimum Experience Experienced
Compensation $23 - $33/hour DOE


Job Summary 


Provides, coordinates and facilitates patient discharge planning in collaboration with other health care professionals during hospitalization, ED visits and/or clinic visits. Assist with organizing services across provider lines, between people, and systems to affect optimal patient outcomes, achieve continuity of care and reduce costs. Serve as a utilization management resource to determine appropriateness of admission, level of care and continued stay.




Essential Functions


  • Promote the mission, vision, and values of the organization.

  • Identifies patients for teaching, discharge, and extended care facility needs.

  • Collaborates with physicians, caregivers, patient, family, other departmental team members, and payor to proactively develop and implement a safe and appropriate discharge plan.

  • Participates in team meetings that foster interdepartmental collaboration with the patient and their family as deemed necessary, this includes multidisciplinary meetings and Utilization Review/Case Management meetings. Provides input in such meetings regarding utilization management and discharge planning.

  • Applies utilization review criteria to assess and document the appropriateness of admission, continued stay, level of care, and readiness for discharge; refers cases that do not meet criteria to Case Management Director and /or Medical Staff.

  • Maintains working knowledge of Medicare, Medicaid and private insurance company coverage for referred products and services.

  • Communicate daily with admissions personnel regarding admissions and discharges to various facilities.

  • Ensures that a quality of care is maintained or surpassed by collecting quality indicators and variance data and reporting the data to the appropriate department; reports and identifies data that indicates potential areas for improvement of care and services provided within the system.

  • Knowledgeable of patient’s financial status, diagnosis and discharge needs and documents these as an ongoing review.

  • Assist as needed with obtaining referrals, prior authorization for Home Health Care, DME, SNF, acute rehab and appointments.

  • Maintains a current list of resources for referrals and refers to the appropriate inpatient, outpatient and community resources.

  • Participate in and complete discharge assessments, complete follow up phone calls in a timely manner and provide referrals/ data according to the patient’s needs.

  • Participate and communicate with the care team in management of the patient through the ACO program and electronic health record meaningful use program.



Non-Essential Functions


  • Perform other duties as assigned



Professional Requirements


  • Adhere to dress code, appearance is neat and clean.

  • Complete annual education requirements.

  • Maintain patient confidentiality at all times.

  • Report to work on time and as scheduled.

  • Wear identification while on duty.

  • Maintain regulatory requirements, including all state, federal and local regulations.

  • Represent the organization in a positive and professional manner at all times.

  • Comply with all organizational policies and standards regarding ethical business practices.

  • Communicate the mission, ethics and goals of the organization.

  • Participate in performance improvement and continuous quality improvement activities.

  • Attend regular staff meetings and in-services.





  • Current registered nurse licensure in the state of New Mexico

  • Three to five years’ experience in discharge planning and Utilization review preferred.

  • Knowledge of Utilization management principles, HCFA guidelines, Swing Bed, home health care, skilled nursing facilities/long term care and durable medical equipment is highly desirable.



Knowledge, Skills, and Abilities 


  • Knowledge of nursing services and insurance coverage preferred

  • Strong organizational and interpersonal skills

  • Ability to determine appropriate course of action in more complex situations

  • Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude

  • Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work

  • Ability to maintain confidentiality of all medical, financial, and legal information

  • Ability to complete work assignments accurately and in a timely manner

  • Ability to communicate effectively, both orally and in writing

  • Ability to handle difficult situations involving patients, physicians, or others in a professional manner



Physical Requirements and Environmental Conditions 



  • Working irregular hours, on call is not required  


  • Physically demanding, high-stress environment


  • Exposure to blood and body fluids, communicable diseases, chemicals, radiation, and repetitive motions


  • Pushing and pulling heavy objects


  • Full range of body motion including handling and lifting patients



  • Position requires light to moderate work with 50 pounds maximum weight to lift and carry.

  • Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.


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  • Location
    Portales, New Mexico
  • Department
    Utilization Review
  • Employment Type
  • Minimum Experience
  • Compensation
    $23 - $33/hour DOE