Posted 1 year ago
Listing Type: Nursing
Employment Type: Nursing
Education Level: Not Stated
Experience Level: All|Experienced
Care Management RN
Send This Job to a Friend
LinkedIn Google+ Facebook Twitter Email
PRN (hours as needed)
Day & evening shifts
Contact: Dana Hatcliff
1600 South 48th Street
RN (Active Nebraska)
2 years experience required
The Care Management RN conducts day-to-day activities for the clinical, psychosocial and utilization coordination of the patient's hospital experience. Proactively consults with the interdisciplinary team which includes but is not limited to hospital patient care staff, physicians, patient support and family and community resources to assure a smooth transition for the patient through appropriate levels of care in order to facilitate quality outcomes.
PRINCIPAL JOB FUNCTIONS:
1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.
2. *Utilizes clinical skills to clinically manage and coordinate patient cases.
a) Reviews and augments patient assessment with situational, cultural, condition and/or risk data as indicated; assists in determination of patient risk for untoward clinical outcomes.
b) Facilitates the synthesis of information and consequent decisions of the interdisciplinary team towards desired patient/family outcomes (clinical, functional, cost and satisfaction).
c) Facilitates timely referrals to physicians (consults), ancillary services/programs (e.g. Pastoral Care, Nutrition and Dining Services) for individualized. assessments/interventions based on initial and ongoing patient assessments.
d) Collaborates with the Physician(s) in managing the patient's length of stay or transfer and determining the appropriate level of care needed for the next phase of the patient's care.
e) Facilitates patient/family participation in care planning, delivery and evaluation.
f) Coordinates patient/family education efforts to promote continuity and optimize learning outcomes.
g) Assists Nurse Manager in ensuring consistent clinical standards of care; identifies opportunities for and utilizes findings from quality improvement and best-practice efforts to enhance patient care, customer satisfaction and cost-effectiveness of services.
h) Conducts patient reviews within 24 hours or next business day using appropriate screening criteria.
i) Ensures physician-specific plan of care is being followed for all patients.
j) Reviews clinical findings and diagnostic reports; correlates medical record findings with patient assessment findings.
k) Ensures appropriate resource utilization relevant to the financial, regulatory and clinical aspects of care; proposes alternative treatment to ensure a cost effective and efficient plan of care.
l) Identifies the Lead Physician in complex cases with multiple practitioners.
m) Participates in the education of all health team members on current healthcare issues (clinical and economic) impacting practice patterns and reimbursement.
n) Refers cases that do not meet criteria to the Attending Physician, followed by the Physician Advisor; the Physician Advisor may refer cases to the appropriate Division/Department Chair of the Medical Staff for final determination of appropriateness.
3. *Provides psychosocial support and intervention.
a) Conducts patient and family needs assessment; identifies risk factors as appropriate.
b) Assists in identifying need for supportive counseling or post discharge extended psychosocial therapy and consults with attending Physician for referral to appropriate provider.
4. *Maintains awareness of financial reimbursement methodology, utilization management, payer/reimbursement practices and regulations and participates in resource stewardship.
a) Ensures patients are placed in the appropriate level of care according to clinical situation and prescribed plan of care; prescreens for financial admits and transfers.
b) Refers and/or coordinates financial counseling for information and initiation of financial assistance forms when needed.
c) Participates in communication of reimbursement information to the patients and families; assists in the preparation and delivery of continued stay documents and denial information.
d) Administers and documents appropriate Hospital Issued Notices of Non Coverage.
5. *Performs transition (discharge) planning activities at the time of admission and throughout the patient's hospitalization.
a) Plans, creates, implements and documents transition plans/for all patients; makes referrals to transition facilities and services; facilitates completion of transfer forms.
b) Assures patient/family have sufficient information and education on transitions from one level of care to another.
c) Participates in interdisciplinary transition planning meetings.
6. *Performs Utilization Management functions.
a) Utilizing appropriate criteria for medical review, performs admission notification for 3rd party payers; conducts continued stay review and provides information to 3rd party payers.
b) Participates in concurrent and retrospective denials and appeals process by researching issues surrounding the denial, participating in all levels of the appeal and process follow-up.
c) Maintains awareness of relevant managed care contract requirements.
d) Pre-screens for clinically appropriate admissions; assists in determination for coverage for post acute services or other transfers.
e) Clarifies current rules, regulations and policies related to the Medicare program, Medicaid program, and third party payer guidelines.
f) Serves as an internal and external resource regarding patient's appropriate level of care, admission status, discharge planning and length of stay.
7. *Promotes quality improvement initiatives and health care outcomes in concert with currently accepted clinical practice guidelines and total quality improvement initiatives.
a) Identifies care issues that prolong patient stays; identifies and works to remove barriers that impede optimal patient outcomes.
b) Evaluates and facilitates documentation to ensure medical record reflects clinical practice.
c) Records and appropriately manages patient and family concerns and complaints promptly.
d) Participates in selection, prioritization and data collection for time-limited clinical quality or research indicators as requested.
e) Identifies, documents and communicates actual avoidable delays in days, services or treatment; recognizes and records avoidable days according to procedure.
f) Documents and resolves/refers any discrepancy from standards of care issues to responsible individuals.
g) Identifies potential risk management or quality issues and resolves through intervention or refers as appropriate.
8. *Confirms discharge disposition and reconciles previous day's discharge disposition code.
EDUCATION AND EXPERIENCE:
Current Registered Nurse licensure from the State of Nebraska or approved compact state of residence as defined by the Nebraska Nurse Practice Act. Minimum of two (2) years recent clinical experience required. Prior care coordination and/or utilization management experience required.
OTHER CREDENTIALS / CERTIFICATIONS:
Basic Life Support (CPR) certification required.
Send to Myself
Current Employees Click Here to Apply
Return to Search Results