RN Care Coordinator

: Job Objective: A brief overview of the position. 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. Reports to RN-Manager Clinical Operations Supervises N/A Ages of Patients Pediatric Adolescent Adult Geriatric Blood Borne Pathogens Minimal/No Potential Qualifications Education Required: BSN or MSN or enrollment in an RN-BSN or RN-MSN program within 1 year of hire and completion within 5 years of hire if hired after July 1, 2012 Licensure/Certification Required: California Registered Nurse Preferred: Certification in Case Management Experience Required: Two (2) years of experience as a Registered Nurse in an acute care setting or case management Specific Skills, Knowledge, Abilities Required Strong clinical and critical thinking skills and ability to establish and carry out complex plans of care for key diagnoses 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 Knowledgeable and able to use established criteria for medical necessity, including Interqual guidelines Knowledgeable about notices of non-coverage/denial letters to patients including Medicare/HSAG, federal and state and guidelines Self motivated, self starter, and able to organize efforts around helping clients have a positive experience Ability to communicate with patients, healthcare professionals, and staff to ensure clear and accurate exchange of information Exercises a high degree of initiative, judgment, and discretion Ability to analyze situations accurately and takes effective action Excellent written and verbal communication skills Hospital-Wide Supporting Commitments GROWTH: Inpatient and outpatient volumes are steadily increasing. Does Not Meet Job Expectations Meets Job Expectations Demonstrates a commitment to change and growth in approach toward daily work Mobilizes the resources and energies of the health system towards success Looks for new business opportunities and makes suggestions for expanding our services Words and actions reinforce Eisenhower as an indispensable health care resource and promotes the likelihood of recommending the health system CLINICAL EXCELLENCE: Ensure that measured outcomes meet/exceed agreed upon expectations. Evidence based clinical practice policies, procedures, and other standards are practiced 100% of the time. Tests, treatments and procedures are thoroughly explained to patients and are understood. Patients, visitors and donors are always safe from harm and prefer Eisenhower because of its high quality. Does Not Meet Job Expectations Meets Job Expectations Adheres to hospital and department safety and compliance policies and procedures Wears identification badge at all times ensuring it can be read Completes annual health, safety, compliance reviews and any department/hospital specific requirements within the expected timeframe Acts as a Steward for Safety and corrects and/or reports any unsafe conditions to extension 4759 or ************* /> Understands the importance of immediately reporting on-the-job injuries online and to your supervisor Accepts responsibility for own work Monitors own work to ensure quality; participates in continuous quality improvement Maintains sound judgment and reasoning; analyzes problems or procedures & selects correct course of action Explains tests, procedures, and services with patients to ensure thorough understanding Engages in opportunities to learn and grow by participating in training and educational programs COURTESY/CARING: Staff always practice good manners, are friendly, polite and emotionally sensitive to each individual whether patient, family, visitor or fellow employee. Does Not Meet Job Expectations Meets Job Expectations Acknowledges each person in a sensitive, friendly contact & offers assistance as needed Provides an "ideal" level of service by taking immediate action in addressing customer requests, needs, and concerns Uses pleasant/appropriate tone and positive verbal/nonverbal/written communication at all times Answers telephone by identifying department and name; and asks "How may I help you?" Treats everyone with courtesy and respect, not making excuses nor blaming other employees or departments; works together to improve customer service PARTNERSHIP: Medical Staff, volunteers and employees are committed and highly engaged. Leadership and the staff are constantly striving for professional growth and applying that new knowledge to innovate and continuously improve direct patient care and other supporting systems and procedures. Does Not Meet Job Expectations Meets Job Expectations Treats co-workers as teammates, accepts/supports team decisions and the roles of others Develops trust and credibility with peers, supervisors, and customers Helps others during slow periods Applies new knowledge to innovate and continuously improve direct patient care and other supportive systems and operations Provides helpful, courteous, timely, and accurate responses to all individual HEALING ENVIRONMENT: A supportive setting is developed and maintained that embraces the physical, emotional, and spiritual aspects of health and healing. Does Not Meet Job Expectations Meets Job Expectations Maintains a professional image and a clean, orderly environment that portrays an overall image of excellence Demonstrates compassion when dealing with difficult situations & takes initiative to resolve Creates a positive environment by not engaging in inappropriate communication Demonstrates a can-do attitude and embraces the culture of performance excellence Actively promotes a supportive setting that embraces the physical, emotional, and spiritual aspects of health and healing by creating a quiet, calm, pleasant and cheerful environment EFFICIENCY: Services are provided efficiently and effectively with a minimum of waste. Does Not Meet Job Expectations Meets Job Expectations Adheres to all rules & standards around productivity, timeliness, overtime, & meal/rest periods Balances individual/team responsibilities to produce more efficiently Pays close attention to detail to standardize work, and eliminate waste and rework Makes a concerted effort to conserve hospital resources, i.e. electricity, supplies, water, etc. Adheres to all hospital, division and department policies and procedures Essential Responsibilities Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations. 1. 2. Ensures that an admission review has been completed within one working day after admission. 3. 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. 4. 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. 5. In conjunction with the physician, the patient and interdisciplinary team, establishes a comprehensive plan of care to appropriately address clinical milestones. 6. 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. 7. 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. 8. Is 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. 9. 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. 10. Coordinates patient transfer to the appropriate level of care. Identifies and facilitates resolution of clinical and operational roadblocks to achieve optimal outcomes by identifying alternatives as needed. Communicates resulting decisions to patient/family, physicians and members of healthcare team, according to regulatory guidelines and hospital policies. 11. Identifies opportunities to improve care/service. Assists in development and implementation of care performance improvement plans based upon analysis of patterns and trends identified from data collection and observations. 12. Demonstrates understanding of payer prior approval requirements and the various health care delivery systems and payer plan contracts. Ensures timely communication with third party payers and/or review organization as necessary and provides information to federal, state, and privates payers and/or review organizations so that determinations regarding benefits and coverage may be made. Provides clinical information requested by providers as part of the concurrent appeal process. 13. Documents all care management assessments and interventions. Inserts most current discharge planning documentation into medical record. 14. 15. Assigns process, social and physician related avoidable days according to established policy and procedure. Ensures that the appropriate level of care is maintained through ongoing continued stay reviews using UR Committee approved criteria. Makes recommendations when alternate levels of care are indicated. 16. Escalates to the UM Committee through the physician advisor or EHR when unable to resolve issues with the attending physician, and as required by federal and regulatory requirements. 17. 18. Educates physicians and staff to understand admission status, appropriate patient placement and other regulatory requirements. Works with ED and Transfer Coordinator to ensure evidence based order sets are initiated upon admission, when available. Follows up to ensure that order sets and clinical pathways are being implemented as available. Monitors and intervenes for variances. 19. Proactively discusses discharge planning needs with the physician and interdisciplinary team. Establishes an initial discharge plan in conjunction with patient and families within 24 hours or as soon thereafter of an assessed need or referral is sent. 20. Rounds regularly with physicians to establish plan of care, and to ensure that care is proceeding in an efficient and effective manner. Follow up to ensure that tests and treatments are proceeding efficiently, and that results are available to physicians on a timely basis. 21. Ensures that the care plan is updated as appropriate, through clinical progression of the patient toward clinical milestones updating the team and patient and family accordingly. 22. Closely monitors the progression of care for the observation patient, and ensure appropriate utilization of resources and efficient throughput for this patient population. 23. Facilitates the initiation of diagnostic services, treatment planning, and therapeutic treatments. Assesses and intervenes to ensure that the patient's treatment plan is current, appropriate and efficient. 24. 25. Identifies and ensures a safe discharge plan and that it is completed at least 24 hours prior to discharge whenever possible. Refers to Social Worker or Discharge Planner for complex psychosocial and discharge planning issues (per criteria) and ensures appropriate follow-up. Consults with other members of the interdisciplinary team (physical therapy, pharmacy, etc.) to provide safe discharge as appropriate. 26. Ensures that any information appropriate to facilitate continuity of care post discharge is communicated to post acute provider via discharge paperwork or via phone per departmental documentation guidelines. 27. Develop strong relationships with community health resources to ensure appropriate patient access after discharge. Completes timely referrals to post discharge providers, ensuring efficient patient flow and adherence to federal and regulatory requirements. 28. 29. Develops, maintains and provides community resource information to patients. 30. Helps patients obtain a PCP (Primary Care Physician) and affordable discharge medications and resources as necessary. 31. Ensure appropriate follow-up appointments are made and patient is knowledgeable about post discharge activities. Issues notices of non-coverage/denial letters to patients based on results of physician reviews and in compliance with Medicare/HSAG, federal and state and department guidelines. 32. 33. Ensures that the Medicare Important Message has been delivered according to hospital policy. 34. Monitors and manages clinical outcomes and intervenes on issues that have the potential to impact quality. 35. Performs other duties as required. Does Not Meet Job Expectations Meets Job Expectations Continuing Education/Training/In-services Continuing Education/Training/In-services Itemized Details N/A Overall Evaluation Overall Evaluation Does Not Meet Job Expectations Meets Job Expectations Summary of Performance Comments (required) Specific Areas for Improvement Comments (required for any DNM ratings) N/A