Clinical Evaluator - RN Hospital

Company: KPC Promise Healthcare LLC
Location: Baton Rouge
Posted on: January 25, 2023

Job Description:

KPC Promise Hospital of BATON ROUGE : The Clinical Evaluator is responsible for collecting and evaluating clinical information and assists in the determination of appropriateness for admission to the facility based on independent discretion and knowledge of InterQual criteria. In addition, he/she evaluates and communicates special needs, potentially high-risk cases, physician and/or insurance objectives, and patient/family dynamics and expectations to the Director of Case Management and Nursing Management.
QUALIFICATIONS:
Current state license as either a Registered Nurse, Licensed Practical Nurse, Respiratory Therapist or Physical Therapist
Two or more years of hospital clinical experience, preferably in an acute care setting
Ability to collect clinical information and apply criteria for potential admission including estimated length of stay, patient/family expectations, and discharge plans
Strong medical assessment skills
Experience in commercial insurance, Medicare and Medicaid reimbursements is preferred
Experience in in-service education and public speaking
Experience in Utilization Review and/or Case Management
Understanding of InterQual and LTACH criteria for admissions and continued stays
Must have a valid drivers license and a clean motor vehicle record, as well as carry applicable insurance as required by state law
Must be able to read, write, and speak English, Bilingual desired
PHYSICAL AND MENTAL REQUIREMENTS:
Physical: Walking - up to 75% Standing - up to 25% Kneeling - up to 15%
Sitting - up to 50% Pushing - up to 15% Bending - up to 10%
Squatting - up to 10% Pulling - up to 15% Reaching - up to 15%
Lifting - up to 50lbs Wrist/Finger Movements - up to 90%
Mental: Stress Level: Moderate to High
EXPOSURE RISK: Category II - Jobs in which required tasks normally do not involve exposure to blood, body fluids or tissues but which could result in Category I exposure.
EQUIPMENT, TOOLS, MATERIALS, MACHINES USED : Pager, cell phone, copier, fax, basic computer skills, understanding of electronic charting, wireless communication
CERTIFICATIONS :RN, LVN/LPN, PT, RT
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Keywords: KPC Promise Healthcare LLC, Baton Rouge , Clinical Evaluator - RN Hospital, Healthcare , Baton Rouge, Louisiana