nThrive

RN Care Coordinator

Job ID
2017-19883
Employment Type
full-time
Naples
Hours Per Week
0.00
FL

Overview

The RN Care Coordinator utilizes professional nursing skills to assess patient needs, the clinical appropriateness of treatment for the setting and establishes plans for effective management through the continuum of care. An RN Care Coordinator educates staff regarding effective allocation of hospital’s resources while encouraging provision of high quality patient care. She/he is cognizant of regulations and policies of all review organizations related to billing of third-party payers, monitors and evaluates options and services to meet the patient’s health needs. The RN Care Coordinator is responsible for organizing a patient's case from admittance to discharge and understands hospital processes and the importance of making cost-effective decisions to navigate the patient through their hospitalization. She/he assesses, plans implements, coordinates, monitors and evaluates options to facilitate the continuum of care. The RN Care Coordinator acts as intermediary between patients, physicians, family members, caregivers, post-acute care providers and the healthcare system as a whole.

Responsibilities

  • Educates staff regarding effective allocation of the hospital’s resources while encouraging provision of high quality patient care; including, but not limited to:
    • Manages a coordination of care model for each assigned patient that is cumulative, complimentary and contiguous; using ongoing interaction with patients, physicians and other health providers to meet designated clinical, operational and financial outcomes for their assigned patients. Assists physicians, patients, families, staff and payers in managing care for assigned patients that is appropriate, effective and cost efficient.
    • Performs an initial assessment of patients within 24 hours of admission focused on immediate short term and transition of care needs to drive expected length of stay consistent with the patient’s working DRG.
    • Confers daily with the attending physician and consulting physician(s) to review and clarify clinical and utilization appropriateness of the treatment plan for assigned patients.
  • Works in conjunction with Utilization Review Team to confirm expected LOS and payer approved days. Keeps the physicians informed of the expected LOS and targets care coordination around meeting this goal LOS. Keeps the Manager of Care Coordination apprised of cases exceeding the LOS target.
  • Documents Avoidable Days within the Cerner UM Module and identifies the correct category for tracking all avoidable days. 
  • Collaborates with the physician and other members of the healthcare team to appropriately achieve the targeted LOS.
  • Visits patients routinely to complete and maintain an assessment that accurately reflects the patients’ condition and response to the plan of care.
  • Follows through with planned interventions and documentation to assure appropriate use of health care resources and take appropriate action to facilitate discharge when a patient fails to meet medical necessity criteria, including independently in identifying the need for HINN, HRR, and IM.
  • Confers with the Care Coordination Manager prior to issuing a HINN or HRR letter.
  • Keeps patient informed of their rights as a patient, including delivering the Important Message (IM) from Medicare.
  • Communicates discharge requirements with patient and notifies patient when their continued hospitalization is no longer meeting medical necessity for the hospital level of care.
  • Identifies the need for patient notifications; including, HINN, HRR and ABN. Notifies Care Coordinator Manager anytime such a medical necessity notice is presented to a patient.
  • Stays abreast of changing length of stay, readmissions, case management, regulatory matters and third party payer requirements. Manages all aspects of the readmissions stratification, prevention and action planning.
  • Conducts a review of the clinical condition of assigned patients prior to daily discharge rounds. Attends discharge rounds prepared to discuss the patient’s progress toward discharge and anticipated needs based upon their clinical progression.
  • Identify patients who will benefit from the assistance of financial counselors and ensure the hospital’s financial counselors or outside contractors are consulted on the patient and follow-up to identify potential opportunities for financial assistance. Work with the financial counselor team to obtain necessary information from the patient and/or family in order to determine eligibility for financial assistance.
  • Collaborates with the patient, the patient’s third-party payer and Utilization Review Team to identify post-acute care options that meet patient needs and assist with information necessary for the Utilization Review Team to obtain timely authorization(s) for services both during and after the patient’s hospitalization.
  • Must have a high level of interpersonal and communication skills and be a demonstrated team player. Must demonstrate reliability and accountability to patients, families and other team members.
  • Consistently documents appropriate information in the EMR to reflect the care coordination efforts during the patient’s hospitalization.
  • Participates in a regular rotation of weekend and after-hours coverage in order to meet
  • Department needs as determined by the Director of Case Management.
  • Attend and actively participate in all departmental and interdepartmental meetings relative to Care Coordination and the proper utilization of hospital resources.
  • Perform other duties as they related to coordination of patient care as directed by the Manager of Care Coordination or the Director of Case Management.

Qualifications

  • Licensed as a Registered Nurse in the State of Florida
  • Certification in clinical case management or utilization review strongly desired.
  • Bachelor’s degree in Nursing (BSN) or Associate’s degree in Nursing (ASN) with Bachelor’s
  • degree in a closely related field preferred.
  • 3 years nursing experience prior to care coordination required; at least 5 years preferred
  • Knowledge of Medicare and Medicaid payment rules, policies and regulations;
  • Strong written and verbal communication;
  • Ability to effectively use MS Word, PowerPoint, Excel and Outlook required;
  • Ability to evaluate medical records and other health care data;
  • Ability to exercise good judgment and tact in relating to third-party payers, physicians and
  • patients;
  • Ability to establish and maintain effective and cooperative working relationships with
  • Hospital staff and others contacted in the course of this position;
  • Ability to accurately complete tasks within established times;
  • Demonstrated ability to effectively prioritize multiple tasks and deadlines; work
  • independently
  • Ability to maintain confidentiality in all tasks performed.
  • Excellent problem solving skills.
  • Demonstrated ability to effectively present information and respond to questions from small
  • groups or on a one-on-one basis.
  • Demonstrated ability to deal with problems involving several concrete variables in
  • standardized situations.
  • Strong presentation skills.

About nThrive

nThrive is the leader in providing end-to-end revenue cycle services, technology and education solutions. Previously known as MedAssets, Precyse, Equation and Adreima, each formerly a leader in its own right, we’ve combined our talents and capabilities into a single enterprise. At nThrive, we are people who are passionate about empowering health care for every one in every community. We work together to transform financial and operational performance, enabling health care organizations to thrive.
 
nThrive is an Equal Opportunity Employer and does not discriminate against any employee or applicant for employment because of race, color, age, veteran status, disability, national origin, sex, sexual orientation, religion, gender identity or any other federal, state or local protected class.

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