Registered Nurse Care Coordinator

Newport News, Virginia

Overview

Works under the supervision of the Manager and the Director and is responsible for working in collaboration with the healthcare team to coordinate the care and service to patients across the continuum of care, promotes effective utilization and monitoring of healthcare resources and assumes a leadership role with the interdisciplinary team to achieve optimal quality, clinical and resource outcomes. Works to provide a comprehensive range of services or clinical care associated with and in accordance with standards of excellence established by Riverside Health system and facility goals and strategic plans. Utilizes national hospital based ACMA Scope of Services and Standards of Practice as foundation of Care Management.

What You Will Do

• Demonstrates the ability to build trusting, collaborative relationships staff, peers, physicians and other disciplines / ancillary services. In addition, capable of completing the problem solving cycle from identification to problem resolution so as to maximize opportunity or minimize problem. Demonstrates behaviors that reflect "commitment to my co-worker".
• Seeks to attain knowledge and competency that reflects best practice for improved outcomes of clinical practice, guidelines and measures promoting the mission, vision and values of RHS.
• Collaborates with the physicians to ensure compliance with level of care assessments based on clinical needs and utilization criteria and issues relevant to noncoverage / possible denials. Provides Screening and identification of patients requiring post-acute care, provides timely assessments, develops plans of care, utilizes sequencing of interventions for safe, timely, efficient, effective, equitable, and patient centered transitional planning. Documents all avoidable days causing delays in throughput.
• Assesses patient records on assigned unit for medical necessity of acute hospital stay and LOS assignment. Performs utilization review activities in accordance with Riverside Regional Medical Center's Utilization Management Plan. Confers regularly with physician on plan of care or continued stay and physician documentation. Participates in daily interdisciplinary planning meetings and weekly outlier case reviews. Coordinates and communicates the discharge plans with team members, patients, and their support systems / families.
• Assesses patients and families to determine needs and available resources so that the needs of the individuals are met in the most cost effective way. Communicates with payors and community resources. Strives to continuously improve the quality, process and outcomes of patient care with consideration of social determinants of health.
• Performs appropriate and timely general discharge planning duties to include arranging home health care, durable medical equipment, referrals to the Medical SW and Medicare IM notification. Performs timely discharge planning interventions for all post-acute transitions of care utilizing the EMR and includes care management assessment, use of readmission screening tools, screening for social determinants of health, and documents Freedom of Choice, Estimated Discharge Date, Care Act compliance, and Discharge Disposition. EMR is used to document all assessments and discharge planning changes that occur and are visible to the interdisciplinary team. Utilizes all databases for efficient patient referrals and advocacy.
• Completes admission / continuing stay reviews to support revenue integrity and refers for PA review as required by regulatory mandates. Documents admission / concurrent payer authorizations and denials. Maintains knowledge and understanding of Medicare / Medicaid, Managed Care and other Payer requirements. Coordinates with utilization management department and Physician Advisor to ensure compliance with CMS regulatory practices such as issuing the Medicare Important Message, Medicare Outpatient Observation Notice, and Detailed Notice of Discharge.
• Maintains knowledge and understanding of Medicare / Medicaid, Managed Care and other Payer requirements and communicates clinical admission and continued stay updates to payers for authorization of hospital stay in a timely fashion.

Qualifications

Education

Experience

Licenses and Certifications

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