Nurse Case Manager - FT - Day

Description

Summary :

The Clinical Care Coordinator - Unit is responsible for providing direction and leadership to the clinical team regarding the patient level of care and discharge transition plan. Acts as principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review and medical records to ensure appropriate status is assigned. Assures patient progression of care is efficient and transition plans are executed to the appropriate level within the care continuum. Provides clinically based concurrent review of the medical record to assess and procure accurate and complete documentation of the patients' diagnoses and procedures. Ensures documentation accurately reflects quality of care, severity of illness and risk of mortality to support correct coding, reimbursement, and quality initiatives.

Responsibilities :

1. Coordinates and directs level of care appropriateness from admission and continuing throughout the entire stay. Uses discretion and independent judgment in applying appropriate initial screening criteria standards as well as maintaining compliance with payer regulations.

2. Prioritizes / delegates daily functions to assure completion of all required tasks.coordinating ambulance and DME.

3. Completes planning using high risk admission data and discharge criteria. Anticipates medical / psychosocial needs in high risk patients, e.g. chronic diagnoses, top ten DRGs, patients frequently accessing care, etc. Screens new patients daily and collaborates with Social Worker to manage elements of case. Collaborates with Care Coordination assistants to meet the administrative needs of the team, i.e. faxing information to 3rd party payers, coordinating ambulance and DME.

4. Manages level of care status throughout stay by performing continued stay reviews, removing barriers to progression of care and revising transition plans as needed.

5. Ensures all appropriate regulatory documents are provided to the patient (MOON, CT notice, IMM, HINN, ABN).

6. Ensures the completion of a discharge needs assessment as well as formulation of a plan on all admissions using appropriate resources (CARL tool for bundled payment cases, Navihealth,etc).

7. Acts as a clinical role model to the healthcare team.

8. Leads and facilitates Multidisciplinary rounds to proactively progress the patient�s plan of care and discharge.

9. Addresses readmission prevention strategies and LOS concerns.

10. Queries members of the Health Care team to obtain accurate and complete documentation to ensure appropriate clinical documentation to support level of care.

11. Coordinates / collaborates to assure the implementation of all discharge plans.

12. Meets and acts on cases not meeting admission criteria and refers to physician advisors all cases requiring immediate review and / or discussion.

13. Proactively interacts with third party payers to prevent denials.

14. Acts as liaison between patient, physician, family, and health care team regarding plan of care and progress towards goals.

15. Provides education to physicians, nurses, and other members of the healthcare team.

16. Provides a concise hand-off to colleagues daily.

17. Tracks / trends variance data and elevates concerns / findings to management.

18. Complies with all standards and policies regarding safety / patient safety initiatives.

19. Fulfills all compliance responsibilities related to the position.

20. Performs other duties as assigned.

Education : ASSOCIATE'S LVL DGRE

Other Information :

Required : This position requires a minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience. Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator. Knowledge and expertise with use of electronic medical record and use of both InterQual and Milliman screening criteria. Excellent collaborator and team member who is able to work closely with physicians and all members of the health care team to procure the right level of care, correct order for hospitalization, optimal plan of care , and facilitation of services. Knowledge and expertise in both CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications. Ability to be flexible, resourceful and creative in problem solving. Excellent communication skills both oral and written.

Minimum Experience : three years

Desired : Certification in Case Management preferred or willing to obtain. Bachelors Degree in Nursing preferred.

Working Conditions :

Manual : Some manual skills / motor coord & finger dexterity

Occupational : Little or no potential for occupational risk

Physical Effort : Medium to Heavy effort. May exert up to 35 lbs. force

Physical Environment : Generally pleasant working conditions

Credentials : RN

Company : Danbury Hospital

Org Unit : 152

Department : Care Coordination-DH

Exempt : Yes

Salary Range : $40.43 - $75.10 Hourly