Registered Nurse Case Coordination Family Medicine

Job Summary

Coordinate patient needs to assure high quality patient care, reduce length of stay; resource utilization; ensure reimbursement drawing on a broad clinical and systems management knowledge.

Responsibilities

• Collaborate with the medical staff and serve as a resource expert regarding documentation, application of appropriateness criteria, alternate levels of care, patient classification, denial information and payment information. Includes collaboration with Physiatrist and Medial Director.
• Facilitate communication with patients, physicians, and families in order to avoid insurance and Medicare denials. Provide information regarding services available to add family/patient in making informed decisions.
• Direct the timely implementation of the plan of care in collaboration with the multidisciplinary team. Serve as a liaison to ensure that all elements critical to the plan of care have been communicated to the patient, family, and members of the multidisciplinary team
• Educate multidisciplinary team regarding documentation in order to assure continuity of care and hospital/physician reimbursement for all services.
• Utilize assessment skills to identify and anticipate discharge and other needs of patients/families.
• Evaluate care based on standards of care and QI process of select population or unit.
• Act as a resource to assist others with patient care management.
• Ensure patient rights are sustained and safeguard patient privacy and confidentiality.
• Coordinate utilization and implementation of internal and external resources.
• Facilitate group process and interdisciplinary problem solving.
• Monitor trends and report practice issues of the multidiscipline health care team that impacts finances and quality care issues. Implement appropriate measures to resolve issues.
• Provide input to department managers on the quality of care which is being provided in the departments (ex: nursing, ancillary).
• Monitor and review quality care issues being provided on a unit level with Department Manager, Clinical Physician Director, and Clinical Quality Specialist.
• Direct attending and consulting physicians, residents, staff nurses and other members of the multidisciplinary team to address system processes that impact the timely delivery of care.
• Collaborate with all members of the multidisciplinary team to facilitate the case coordination process for designated case load. Monitor the patient's progress, intervening as necessary and appropriate, to ensure the plan of care and services provided are patient focused, high quality, efficient, and cost-effective.
• Support Collaborative Practice Committees and develop methods to optimize resource utilization in order to achieve quality outcomes.
• Collaborate with multidisciplinary team to identify patient needs, assess patient progress against the care map, address family and patient discharge needs and make appropriate referrals to address those needs. Facilitate identified improvement processes are appropriate. Assist the Physiatrist or manager/medical director for post acute services.
• Assist with development and tracking of quality indicators and collection of variance data.
• Apply variance tracking data to facilitate system changes or changes in practice, and facilitate quality management activities including screening, focus studies, and others.
• Recommend improvements based on variance tracking.
• Identify educational needs of the staff and physicians and provide continuing education.
• Participate in hospital/unit committees as requested.
• Maintain communication with patients, families, and visitors to ensure high level quality care for patient satisfaction.
• Keep the patients medical record current.
• Integrate continuous, quality improvement into department and institution operations, and demonstrate a commitment to the process.
• Serve as patient/family advocate.
• Initiate collaborative action towards identified barriers to quality.
• Post Acute Services specific: Complete the pre-admission screening, document pre-admission form prior to admission: identify patient goals; assess discharge plan and resources; verify family support; identify payment source; obtain insurance approval/pre-certification. Assure that all requirements are met for admission.
• Communicate with rehabilitative services administration and physiatrist regarding specific patient care issues to Medical Rehabilitation. Communicate with skilled nursing services administration and Medical Director regarding specific issues related to skilled nursing issues.
• Act as a link to the community by responding to referrals outside of CAMC within 24 hours from other hospitals, physicians, and individuals.
• Make a daily review of patients on waiting list to determine readiness for admission.
• Maintain and distribute daily admission/discharge sheet. Update patient waiting list prioritizing patients and keeping case coordinators, patient, family, and physicians updated to facilitate admission to post acute services.
• Share call responsibilities with other PASCs, including weekend call or facilitating admissions.
• Participate in various meetings: discharge meetings on appropriate units to ensure/facilitate discharge planning from acute units and admission to post acute care occurs in a timely manner including communicating with patient, family, and physicians.
• Update insurance company as required, while keeping team members informed.
• Serve as a liaison with the referring physician
• Provide in-service education and serve as a resource for rehabilitation nursing topics, such as admission criteria and appropriate consults and patient selection to include clinical readiness for admission to Medical Rehabilitation Center.
• Participate in performance improvement councils in order to share data and develop methods to optimize resource utilization in order to achieve quality outcomes.
• Promote coordination of services to proper patient selection to reduce potential re-admission of high-risk patients.
• Utilize tracking methods to facilitate system changes or changes in practice and participate in quality management activities, including screening, focus studies and others.
• Supervision and leadership of the acute case coordinators with regard to post acute services and care coordination of patients accepted into CAMC Medical Rehabilitation Center.
• IRF/PAI Coordinate assessment process, data collection, and submission of data to designated agencies and departments within mandated time frames.
• Responsible for submission of required data to Medicare/UDS within 72 hours of admission as specified by PPS.
• Assure all appropriate co-morbidities and diagnoses are correctly coded and entered on IRP/FIM and contains all required data and signatures for submission.
• Assist with the monitoring of conformance to CARF standards in section IOM in relation to data collection and tracking of admissions and discharges.
• Identify timelines for RAP completion and track information to ensure all RAP summary sheets are completed by specific disciplines.
• Assist with monitoring of compliance of 75/25 rule.
• Review care plan prepared for patient and collaborate with staff in care of patient.
• Work closely with the Program Director to ensure program compliance with CARF/UDS/MEDICARE and participate in continuous quality improvement processes.
• Ensure that only UDS credentialed staff administer the IRP/FIM and identify unit educational needs regarding assessment process.
• Coordinate quarterly peer review audit of representative sample patient charts to evaluate validity of assessment data by comparing patient function as reflected in FIM scores with patient function as described in chart documentation.

Knowledge, Skills & Abilities

Patient Group Knowledge (Only applies to positions with direct patient contact)

The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.

Competency Statement

Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.

Common Duties and Responsibilities

(Essential duties common to all positions)

1. Maintain and document all applicable required education.

2. Demonstrate positive customer service and co-worker relations.

3. Comply with the company's attendance policy.

4. Participate in the continuous, quality improvement activities of the department and institution.

5. Perform work in a cost effective manner.

6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.

7. Perform work in alignment with the overall mission and strategic plan of the organization.

8. Follow organizational and departmental policies and procedures, as applicable.

9. Perform related duties as assigned.

Education

• Bachelor's Degree (Required) Education: Bachelor's Degree- Nursing, Knowledge of current nursing principles, techniques, & procedures, Knowledge of hospital routine as it relates to admission & third party Experience: 7-10 Years: 5 years experience pertinent to position, 2 Years of utilization/case management Substitutions: Associates degree + 9 years relevant experience may substitute for Bachelors degree and 7 years experience.

Credentials

• Rehab RN, Cert (Required)
• Registered Nurse (Required)

Work Schedule: Days

Status: Full Time Regular 1.0

Location: Heart & Vascular Center

Location of Job: US:WV:Charleston

Talent Acquisition Specialist: Lauren R. Lane lauren.lane@vandaliahealth.org