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Role Summary:
The RN CM Care Coordinator will facilitate the interdisciplinary plan of care with a focus on evaluating the appropriateness of clinical care, medical necessity, admission status, level of care, and resource management. The RN CM Care Coordinator will coordinate activities that promote quality outcomes and patient throughput while supporting a balance of optimal care and appropriate resource utilization. The RN CM Care Coordinator will identify potential barriers to patient throughput and quality outcomes and will facilitate appropriate discharge plans.
Essential functions:
- Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
- Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
- Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization
- Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of car; patient selection should be criteria based and interventions will be documented
- Evaluates admissions for medical necessity using approved criteria at defined intervals throughout the episode of care; escalates medical necessity and admission status issues through the established chain of command
- Evaluates and assess observation patients for appropriateness in observation status
- Performs utilization management reviews and communicates information to third party payors
- Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
- Demonstrates knowledge of regulatory requirements, Hospital Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
- Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Facilitates patient throughput with an ongoing focus on quality and efficiency
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
- Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
- Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
- Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs
- Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
- Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
- Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
- Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
- Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered.
- Demonstrates knowledge of the occurrence reporting system. Uses system to report potential patient safety issues.
- Follows established guidelines for reporting a significant medical error or unanticipated outcome in the patient’s care which results in patient harm.
- Attends in-service presentations and completes all mandatory education requirements.
- Uses Performance Improvement Plan to improve patient safety.
- Regular, Punctual and dependable attendance.
- Other duties as assigned
Qualifications:
- Candidates are required to have a minimum of 3 years of RECENT (Within the last year) Case Manager experience in an acute care setting. The HM is also open to candidates with 3 years of experience on the following units: Med/Surg, Tele, Neuro, ICU, PCU, or ED. *will also consider candidates with Case manager experience in home health or insurance. For home health and insurance, they must have 3 years of acute care experience total and must have at least 1 year of acute care experience within the last 5 years.
- Associates Degree in Nursing or Diploma in Nursing required
- Bachelor’s Degree in Nursing preferred
- Current FL RN license required or appropriate compact licensure. If compact license held, active FL RN licenserequiredwithin90 days of hire
- Advanced Practice Registered Nurse license is acceptable for position if current and compliant
- Certification in Case Management, Nursing, or Utilization Review, preferred