RN-Care Coordinator

Job Description

Job Objective:
Determines the appropriateness of hospital admission, and advocates, coordinates and facilitates the interdisciplinary plan of care to expedite medically appropriate, effective, efficient and timely utilization of resources for maximum patient outcomes. Partners with the charge nurse, social worker, physician and other members of the interdisciplinary team to facilitate safe and timely discharge, and intervenes as appropriate to remove barriers to efficient patient throughput and smooth patient transition.

Applies clinical expertise and medical appropriateness criteria to resource utilization, admissions and discharge planning.

Job Description:

Education:

Required:

Bachelor of Science in Nursing (BSN) or Master's degree in Nursing

Licensure/Certification :

Required:

California Registered Nurse (RN) licensure
Preferred:
Certification in Case Management

Experience:

Required:

Two (2) years of experience as a RN in an acute care or case management setting

Essential Responsibilities:

* Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.

* Ensures that an admission review has been completed within one working day after admission.

* Transitions with the ED Care Coordinator and Transfer Coordinator for patients admitted to inpatient/observation level of care.

* Performs a comprehensive assessment of patient's clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues.

* Establishes rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information.

* Collaborates with the physician, patient and interdisciplinary team to establish a comprehensive plan of care to appropriately address clinical milestones.

* Communicates plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team; facilitates communication between the physician, interdisciplinary team, patient and family.

* Gathers sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost effective manner.

* Acts as a resource to staff and physicians regarding appropriateness of admission and continued stay, levels of care (including related documentation requirements), quality of care concerns and criteria/guidelines/protocols utilized in care planning and resource utilization.

* Organizes, integrates and evaluates the effectiveness of the plan of care and progress toward achievement of desired outcomes. Modifies plan of care as patient/family needs change to accomplish goals established in the plan of care.

* Coordinates patient transfer to the appropriate level of care. Identifies and facilitates resolution of clinical and operational roadblocks to achieve optimal outcomes by identifying alternatives as needed. Communicates resulting decisions to patient/family, physicians and members of healthcare team, according to regulatory guidelines and hospital policies.

* Identifies opportunities to improve care/service. Assists in development and implementation of care performance improvement plans based upon analysis of patterns and trends identified from data collection and observations.

* Demonstrates understanding of payer prior approval requirements and the various health care delivery systems and payer plan contracts. Ensures timely communication with third party payers and/or review organization as necessary and provides information to federal, state, and privates payers and/or review organizations so that determinations regarding benefits and coverage may be made. Provides clinical information requested by providers as part of the concurrent appeal process.

* Documents all care management assessments and interventions. Inserts most current discharge planning documentation into medical record.

* Assigns process, social and physician related avoidable days according to established policy and procedure.

* Ensures that the appropriate level of care is maintained through ongoing continued stay reviews using UR Committee approved criteria. Makes recommendations when alternate levels of care are indicated.

* Escalates to the Utilization Management Committee through the physician advisor or EHR when unable to resolve issues with the attending physician, and as required by federal and regulatory requirements.

* Educates physicians and staff to understand admission status, appropriate patient placement and other regulatory requirements.

* Works with ED and Transfer Coordinator to ensure evidence based order sets are initiated upon admission, when available. Follows up to ensure that order…