Hospital Nurse Care Coordinator​/Utilization Management Specialist

Overview

Salary: $38.39-$57.27 per hour, based on experience and qualifications.
SUMMARY Responsible for providing care coordination to patients during their acute stay and the transition from acute care to the next level of care. This individual will be the leader in coordinating with the interdisciplinary team to develop a safe discharge plan for the patient, including involving the patient and family in health education. Coordination of care begins with the patient at diagnosis and remains throughout the entire chronic disease journey including diagnosis, treatment, maintenance of quality of life, survivorship and/or end of life.

This person is the expert in acute illnesses, community education on optimizing health, disease prevention and education. Assists in coordinating and communicating patient needs to the multidisciplinary care team. Concurrently reviews and assists in determining appropriate patient admission status, level of care, and discharge planning. Resource for discharge appeals, denials, insurance communication and regulations. Responsible for utilization management plan.

• Utilizes clinical and applied knowledge of utilization principles to evaluate pre-admission, hospitalization, and discharge criteria.
• Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health care facility to comply with government and insurance company reimbursement policies.
• Documents as appropriate in organization documentation system.
• Round at the bedside with provider on all inpatients daily, with prioritization being patients who may be discharging that day to initiate education regarding their primary reason for hospitalization and goals needed for discharge to next level of care.
• Assess patient degree of understanding during education by asking them to explain in their own words the details of their plan of care (Teach back method).
• Help facilitate and deliver a written discharge plan for the patient that contains: (Teach back method will be utilized to deliver education)
• Reason for hospitalization
• Discuss any tests or studies that have been completed while in the hospital and discuss follow up, if needed.
• Discharge medication list including what to take, how to take them and how to obtain the medication. This includes assessing desire for meds to beds program at Welia for patients.
• Instructions on what to do if their condition changes
• Confirm patient knows where to go, has a plan about how to get to their appointments

Ensure and help inpatient team make follow up appointments, with input from patient and family. Provide telephone reinforcement of the discharge plan and problem solving 2 — 3 days after discharge. Assist and collaborate with other nursing team members and social services to contact family members who will share in the care-giving responsibilities. Maintain a level of med/surg hospital nursing competency to remain knowledgeable and skillful in acute illnesses, related to hospitalization and hospital nursing duties needed to deliver care.

This will be done through annual competency validation required for Welia med/surg nursing. Identifies barriers and works with patient/family to resolve them. Facilitates communication between patient/family and all members of the health care team. Helps deliver call backs on group of Welia CCM patients who have chronic health conditions to assess needs and begin education of treatment plan and coordination of appointments/services.

Works with the patient/family/healthcare provider to develop, initiate and implement a treatment plan which enhances patient outcomes. Collaborates with patients and family members in decisions regarding the patients care. Follows the patient over time, providing continued education support and resource options. This person will continually utilize the nursing process and collaborate with patient and family to adapt plan to meet changing needs.

Assesses physical, psychological and social dimensions of patients and develops and follows a plan of care for patients. Functions as patient team member working collaboratively with other patient care team members to ensure appropriate level of patient care. Implements clinical and technical aspects of care and nursing orders in accordance with established policies and procedures. Intervenes with proper technique, procedure and safety precautions to meet individual needs of patient.

Acts as a resource person regarding patient care, specialty area, orientation and teaching of staff. Assesses, plans, implements and evaluates personal growth and learning development needs. Possesses excellent communication skills, verbal telephone, written, to ensure accurate and adequate communication. Participates in and supports research programs and activities; also participates in nursing meetings, committees and other activities which promote the growth and development of nursing and/or patient care.

Functions and supports the Joint Commission standards, Welia Health and…