Registered Nurse (RN) - Care Coordinator Utilization Review

$10,000 Sign On Bonus

The Care Coordinator RN is to ensure that each patient is treated at the appropriate level of care and that transition to the next level is appropriate and complete. The Care Coordinator RN will work under the director of the department to coordinate a multidisciplinary approach to organize and coordinate effective, efficient, quality care. The coordinator will work within the multidisciplinary team to develop a transitional plan that is appropriate for the patient as related to benefits, resources, and medical conditions. The coordinator actively uses assessment, planning, implementation, coordination, monitoring, and evaluation. The coordinator strives for improvements in the quality and cost-efficiency of medical care and the client's quality of life.

Education

Associate Degree or 2 years of college coursework

Experience

Three years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.

Licenses & Certifications

• Georgia Registered Nurse License or Multistate Nursing License

Qualifications

• A minimum of three (3) years of case management experience is preferred.

• A minimum of three (3) years of clinical experience, medical-surgical experience preferred.

• Ability to function within a synergistic team concept.

• Current Georgia RN license. BSN/MSN preferred.

• Demonstrated ability to analyze and organize information and data.

• Demonstrated ability to organize, prioritize, and make appropriate decisions following organizational and departmental policies and procedures with minimal supervision.

• Demonstrated initiative, critical thinking, and problem-solving skills.

• Demonstrated interpersonal skills. Excellent verbal and written communication skills.

• Demonstrated professionalism, integrity, and ethical behavior.

• Knowledge of utilization review guidelines, case management principles, and regulatory and accreditation standards.

Requirements: Area of Responsibilities

• Communication: Takes a leading role in the interdisciplinary meeting related to the care transition of the patient. Communicates concisely with the care team to develop a comprehensive plan for care transition. Communicates effectively to the family, patient, physician, and members of the team any change in the transitional plan. Has ongoing communication with the team member managing utilization regarding the patient's clinical course and transitional plan. Communicates effectively with external customers that may include Tanner Medical Group physicians and staff, community physicians, nursing facilities, DME vendors, LTAC companies, hospice companies, and other acute care facilities, etc. Communicates post-discharge with patient support to facilitate ability for care to be maintained at a lower level of care.
• Job Knowledge: Provides care coordination of given population of patients using knowledge regarding care transitions, disease process, nursing process, utilization management, and best practice standards. Also, shows understanding related to patient benefits, patient assistance programs, community resources as related to continuum of care. Development of transitional plan using assessment, planning, implementation, coordination, monitoring, and evaluation. Aggregates and analyzes data related to care transitions.
• Judgement and decision making: Identifies, initiates, and facilitates an appropriate transitional plan after assessing the patient's needs and desires, benefits, support, health care status, and other factors. Has ongoing communication with the physician and other health care team members to facilitate the most appropriate plan for the patient. Demonstrates good judgement when dealing with complex family dynamics and difficult patient situations. Has involvement with commercial audits and denial management as assigned. Demonstrates insight and judgement regarding decisions that impact reimbursement and compliance. Demonstrates knowledge in review of RAC audit, denials, and appeal opportunities.
• Leadership Skills: Takes an active role in the department, demonstrating good citizenship and customer service. Actively participates in special projects when requested. Takes responsibility for personal professional development. Demonstrates responsible behavior when dealing with private health information and sensitive patient family issues, showing professionalism. Acts as a hospital liaison to outside agencies, families, and members of the community.
• Professional Qualities: Complies with corporate facility professional requirements, personal standards, and policies at all times. Demonstrates Tanner values, including customer service, lifetime learning, teamwork, integrity, quality focus, respect, and caring. Maintains professional competence through participation in continuing education and other learning experience.

Compliance Statement
Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Education
Associate Degree or 2 years of college coursework

Experience
Three years of related experience. Requires working knowledge of specialized practices, equipment, and procedures.

Licenses & Certifications

• GEORGIA REGISTERED NURSE LICENSE OR MULTISTATE NURSING LICENSE

Supervision

• None.

Qualifications

• A minimum of three (3) years case management experience preferred.
• A minimum of three (3) years clinical experience, medical surgical experience preferred.
• Ability to function within a synergistic team concept.
• Current Georgia RN license. BSN/MSN preferred.
• Demonstrated ability to analyze and organize information and data.
• Demonstrated ability to organize, prioritize, and make appropriate decisions following organizational and departmental policies and procedures with minimal supervision.
• Demonstrated initiative, critical thinking, and problem solving skills.
• Demonstrated interpersonal skills. Excellent verbal and written communication skills.
• Demonstrated professionalism, integrity, and ethical behavior.
• Knowledge of utilization review guidelines, case management principles, and regulatory and accreditation standards.

Definitions

• The role of the Care Coordinator RN is to ensure that each patient is treated at the appropriate level of care and that transition to the next level is appropriate and complete. The Care Coordinator RN will work under the director of the department to coordinate a multidisciplinary approach to organize and coordinate effective, efficient, quality care. The coordinator will work within the multidisciplinary team to develop a transitional plan that is appropriate for the patient as related to benefits, resources, and medical condition. The coordinator actively uses assessment, planning, implementation, coordination, monitoring, and evaluation. The coordinator strives for improvements in the quality and cost-efficiency of medical care and the client's quality of life.

Contact With Others
Requires frequent contact with many persons at different levels inside and outside of the organization to carry out organization policies and programs and obtain willing acceptance, consent, or action.

Effect Of Error
Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient’s welfare or the organization’s interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization’s position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.

Supervisory Responsibility
Exercises no supervision, work direction, or instruction of other employees or students

Mental Demands
Work involves a variety of complex problems to be solved under general organization policies. Ingenuity and judgment are required to review facts, plan work, estimate costs, and deal with factors not easily evaluated, interpret results, draw conclusions, and take or recommend action. Solutions to problems often require coordination with other departments.

Physical Effort
Minimum physical effort - Physical demands encountered are those of a typical office job.

Working Conditions
Minor - Occasionally involved in exposure to dirt, odors, noise, or some work is performed with exposure to temperature/weather extremes/occupational risk and probability of coming into contact with blood borne pathogens, other potentially infectious diseases, or biomedical/bio-hazardous materials.

Physical Aspects

Continually (at least once per day)

• Visual

Frequently (at least 3 times a week)

• Typing
• Hearing
• Speaking
• Standing
• Walking

Occasionally (at least once a month)

• Bending
• Reaching – above shoulder
• Reaching – below shoulder
• Running - In response To an emergency
• Lifting up To 25 lbs.
• Handling – seizing, holding, grasping
• Carrying
• Kneeling
• Squatting
• N95 Respirator usage (PPE)