RN-Care Coordinator Job Rancho Mirage area,California USA,Nursing

Job Objective

Determines the appropriateness of hospital admission, and advocates, coordinates and facilitates the interdisciplinary plan of care to expedite medically appropriate, effective, efficient and timely utilization of resources for maximum patient outcomes. Partners with the charge nurse, social worker, physician and other members of the interdisciplinary team to facilitate safe and timely discharge, and intervenes as appropriate to remove barriers to efficient patient throughput and smooth patient transition.

Applies clinical expertise and medical appropriateness criteria to resource utilization, admissions and discharge planning.

Job Description Education

Bachelor of Science in Nursing (BSN) or Master’s degree in Nursing

Licensure / Certification

California Registered Nurse (RN) licensure (Required)
Certification in Case Management (Preferred)

Experience

Required:

Two (2) years of experience as a RN in an acute care or case management setting.

Reports To

Clinical Manager or Director

Skills, Knowledge and Abilities

Ability to analyze situations accurately and takes effective action
Ability to communicate with patients, healthcare professionals, and staff to ensure clear and accurate exchange of information
Ability to use established criteria for medical necessity, including Interqual guidelines
Exercises a high degree of initiative, judgment, and discretion
Knowledgeable about notices of non‑coverage/denial letters to patients including Medicare/HSAG, federal and state and guidelines
Knowledgeable about regulations, standards and legislation (local, state and federal) related to the continuum of care and patient transition
Knowledgeable about the various health care delivery systems and payer prior approval requirements
Self motivated, self‑starter, and able to organize efforts around helping clients have a positive experience
Strong clinical and critical thinking skills and ability to establish and carry out complex plans of care for key diagnoses
Written and verbal communication skills

Essential Responsibilities

Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.

Ensures that an admission review has been completed within one working day after admission.

Transitions with the ED Care Coordinator and Transfer Coordinator for patients admitted to inpatient/observation level of care.

Performs a comprehensive assessment of patient’s clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues.

Establishes rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information.

Collaborates with the physician, patient and interdisciplinary team to establish a comprehensive plan of care to appropriately address clinical milestones.

Communicates plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team; facilitates communication between the physician, interdisciplinary team, patient and family.

Gathers sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost effective manner.

Acts as a resource to staff and physicians regarding appropriateness of admission and continued stay, levels of care (including related documentation requirements), quality of care concerns and criteria/guidelines/protocols utilized in care planning and resource utilization.

Organizes, integrates and evaluates the effectiveness of the plan of care and progress toward achievement of desired outcomes. Modifies plan of care as patient/family needs change to accomplish goals established in the plan of care.

Coordinates patient transfer to the appropriate level of care. Identifies and facilitates resolution of clinical and operational roadblocks to achieve optimal…