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RN Care Coord Inpt-Edgewood Care Coordination- Part-time, 20 hours weekly

Job Description

The Care Coordinator, in collaboration with the patient/family, social workers, physicians and interdisciplinary team, ensures patient progression through the continuum of care in an efficient and cost effective manner.  Primary responsibilities include:

  • Identifying, initiating and managing optimum patient flow/throughput to enhance continuity of care
  • Planning and facilitating coordinated, safe transitions to the next level of care required
  • Promoting patient satisfaction, and quality outcomes.
  • Targeting an optimal length of stay based on the patients individual response to treatment, procedures, and interventions. Maximizes contracted benefits and available services in care management planning.
  • Providing care management planning to ensure quality patient care, ensures regulatory compliance, and meets patient/family needs.

Demonstrate respect, dignity, kindness and empathy in each encounter with all patients, families, visitors and other employees regardless of cultural background.

 

SECTION II – KNOWLEDGE, SKILLS & EXPERIENCE – Include Desirable Section

 

List the minimum knowledge and skills required to begin working in this position and the additional knowledge and skills that are desirable, but not essential. 

 

MINIMUM

DESIRABLE

Graduate of an accredited baccalaureate school of nursing or related field. Licensed as an RN to practice nursing in the state of Kentucky. Meets contact hour requirements for licensure, including all state required courses.

 

Specialized Knowledge: 

Knowledge of state and federal regulatory issues, payor strategies, payment methodologies, benefit plan designs and limitations. Working knowledge of SEHC policies and procedures. Good organization, critical thinking, problem solving, and communication skills. Excellent human relations skills and team leadership abilities.

 

Kind and Length of Experience: 

2 years’ experience in acute care

 

 

Job Competencies:  Goal-Oriented, Organized, Straightforward, Supportive, Collaborative, Persuasive, Analytical, Decisive, Independent

 

SECTION III – MAJOR ACTIVITIES AND END RESULTS

 

List, in brief statements, the major activities and end results for which this position is accountable.  Most positions will have between five and eight major activities/end results. Describe the position so that someone unfamiliar with your position will understand what is done, and why it is done. Weigh each major activity/end result based on its importance relative to the total job (i.e.: 10%, 20%, 45%).      

 

 

 

Job Duties

Insert “*” to classify Essential Function

% of Time (must total 100%)

1

On a concurrent basis the Care Coordinator (CC) utilizes appropriate/standardized criteria to determine the optimal level of care required for the patient and alternate care delivery options. 

  • On concurrent basis, assesses the appropriateness of the level of care/care management; diagnostic testing and clinical procedures; quality and clinical risk issues; and documentation of medical record completeness.  Records variances through the established care coordination and quality improvement processes.   Documents all reviews in designated software system.
  • Conducts admission and concurrent medical record review using established medically necessity criteria as described by policy in accordance with regulatory and contractual requirements as well as internal policy. Screens for appropriateness of admission (IP vs Observation) and continued stay for medical necessity. Escalates as appropriate per policy Reviews clinical and demographic information for accuracy and completeness to ensure that hospital care delivered meets payer requirements for observation or inpatient services. 
  • Acts as a resource and provides staff and physician education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery
  • Assists in monitoring critical care bed utilization.

*

25%

2

  • Ensures patient progression through the continuum in an efficient, cost effective manner in collaboration and communication with patient/family, physicians and the interdisciplinary team. Acts as patient advocate by negotiating for and coordinating resources with agencies and vendors during inpatient and transitions to post-acute care.
  • Performs initial Care Management assessment to determine care coordination and discharge planning.
  • Coordinates and implements the discharge plan for patients with post- acute care needs in collaboration with the Social Worker Identifies patients/family for Social Worker referral who would benefit from support needed to better enable patients/family in dealing with impact of illness on family functioning and achieving maximum benefits from healthcare services.
  • Participates in ongoing communication with physician to develop a collaborative relationship aimed at improving clinical treatment goals and appropriate and timely discharge for the patient. Comprehensively assesses patient’s biophysical, psychosocial, and environmental needs focused toward discharge planning initiatives – makes appropriate referrals.
  • Provide expertise and support to the treatment team regarding the management of chronic disease/complex patients.
  • Identifies and participates in the development of strategies to reduce unnecessary LOS, resource consumption, implementing and documenting results.
  • Provide expertise to the team in developing treatment and discharge planning strategies for frequently admitted patients.
  • Ensures that the proper sequencing and scheduling of interventions, treatments and procedures are in accordance with the patient’s treatment plan, that care is expedited and care delays and denial of payment are avoided.

Identifies (internal and external) variances/obstacles to efficient or timely care and positive patient outcomes and intervenes with the healthcare team to overcome or eliminate these when possible.

*

25%

3

Interacts with or provides information for third party payers/review agencies to coordinate certification requirements, LOS treatment planning and other benefit utilization issues.  An established procedure is utilized to resolve denial of care, conflicts over care, service or payment. 

  • Assists in coordinating pre/post hospital care within SEH, providers, and community health services.
  • Coordinates the utilization of benefits and resources in the course of care.
  • Works and communicates the plan of care effectively with patient/family; medical staff; caregivers, healthcare team members and third party payors.
  • Works confidently to identify an effective approach to task/problem.  Communicates with patient to ensure understanding of discharge planning referrals as ordered by physician and third party guidelines.
  • Assists with negotiation of financial arrangements for reimbursement for out-of-network services. 

*

20%

4

Document patient medical necessity criteria and discharge planning activities according to departmental policies. 

  • Completes data collection via designated software for all patients.
  • Identifies and documents risk management, quality and infection control issues and communicates to appropriate departments/services
  • Communicates only appropriate necessary information on chart applicable to the referral source in accordance with HIPPA guidelines

*

15%

5

Stays abreast of changing clinical trends, criteria, regulatory matters and third party payer requirements related to clinical care, discharge planning and precertification of after care benefits along with Medicare, Medicaid guidelines, rules and regulations. Participates in the development of process/systems to measure/monitor clinical practice. Obtains reviews and analyzes LOS, resource utilization, outliers, readmissions, denials and delay days for assigned patients. Attends organizational committees, arriving on time and prepared, and implements/communicates information.  Engages in educational opportunities to maintain professional competencies.

*

5%

6

Provides to patients, families, and hospital staff education regarding post-acute services (home health services, ECF, Hospice, etc. Opportunities for conducting education may include patient families at bedside, one-on-one staff education, and unit department meetings

*

5%

7

Performs other duties as assigned.

 

5%

 

TOTAL:

100%

NOTE:  Remove blank rows and use mouse to right-click on total amount above.  Click “update field” from list for auto-sum~

 

The associate shall follow the applicable safety steps required to perform their duties to ensure safety for themselves and their patients, and be in compliance with Medical Center, State, and Federal safety standards.  Examples of such steps may include:  performing proper safety procedures and precautions; reporting safety concerns and incidents; using correct lifting techniques and disposing of sharps and infectious waste properly.

 

For Clinical and related positions - The associate must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on their assigned unit.  The associate must demonstrate knowledge of the principles of growth and development over the life span focused on the assessment, treatment and care of the newborn, infant, pediatric, adolescent, adult, and geriatric patients.             

               

Required:  Employee must successfully complete an orientation process that identifies skills needed to practice in their position and in their job assignment. Skill requirements must be met and maintained to ensure employee competency. This is achieved through an annual review of those particular skills and a work improvement plan for any non-compliant area.

 

SECTION IV – PROBLEM SOLVING

 

Briefly describe two or three typical problems this position must resolve to achieve the end results listed in Section III.   

  1. The CC completes an initial assessment and determines the patient does not meet criteria for acute hospitalization. The determination is discussed with the physician who is unwilling to consider an alternate delivery setting.  The CC works with physician advisor assessment and interaction.  The CC communicates with the payer regarding activities that relate to the payer and facilitates a plan that minimizes the patients financial risk from care provided in an acute level of care that did not require the acute care setting intensity of service. 
  2. The CC completes a discharge assessment and identifies post-acute care needs and arranges for a skilled facility.  The family desires another facility that is closer to their home however their desired facility does not have any open beds.  Patients will be served a letter of Medicare non-coverage if the family chooses to keep patient in the hospital waiting for the desired ECF when another bed is available in the community. 
  3. The CC is working with a patient that has no insurance benefits, does not qualify for Medicaid, is not safe to go home alone (i.e., non-compliant with their diabetic foot care) and family is out of town and/or is not engaged in the care of the patient.  Working with outside community agencies, etc. is necessary in order to move this patient to another setting promoting health while managing resources.

     

SECTION V – SCOPE OF POSITION

 

1

Who (by title) does this position report to?    

Manager of Care Coordination/Social Services

  • Indicate type of supervision provided (Direct or Indirect?)

Direct

2

Who (by title) reports directly to this position?

None

  • Indicate type of supervision provided (Direct or Indirect?)

None

3

Total number of FTE’s reporting to this position:

None

4

Annual operating budget (if applicable):

None

5

Other dollar measures of accountability?

On-going cost containment measures regarding labor and supplies.               

 

 

SECTION VI – WORKING CONDITIONS

 

Describe unusual working conditions such as physical effort, exposure to environmental conditions and exposure to hazards.

 

SECTION VII – ADVANCEMENT TO NEXT POSITION

 

Identify the most likely future position(s) of advancement.  This position(s) may be a higher level or equivalent level job within or outside the department.  Advancement criteria, such as required technical knowledge (skills, education, experience), managerial capabilities, and problem solving skills should also be noted. 

 

Next Likely Position(s):

Care Coordinator Team Lead

Advancement Criteria:

Meets or exceeds performance standards

Vacant position

Meet or exceed minimum qualifications for next level

 

SECTION VIII – GENERAL

 

Describe anything else which is important to this position, such as unique aspects which make it different from similar positions.       

 

SECTION IX – APPROVALS

                                                                                                           

 

 

 

/

 

Prepared By: Wendie Parrott, CSW

 

Title: Manager of Care Coordination

 

Date

 

 

 

 

/

 

Approved By System Director: Sara Briggs, MSN, RN, NEA-BC, CCRN

 

Title:  System Director of Discharge Planning & Patient Logistics

 

 

Date

 

 

 

 

/

 

Human Resources Review

 

Title

 

Date

 

 

 

 

/

 

Authorization for Job

(Re)– Evaluation (Vice President)

 

Title

 

Date

 

                                                                BI-ANNUAL REVIEW WITH NO CHANGE

 

 

 

 

/

 

Approved By Director

 

Title

 

Date

 

 

 

 

/

 

Human Resources Review

 

Title

 

Date

 

SECTION X – PHYSICAL DEMAND LEVELS

 

  1. Work Levels / Frequency Codes - Defined as the percentage of time this particular activity is required in the performance of the job.  Use one of the following letters: C, F, O, I, or R as defined above.

     

C

Constant

61-100%

F

Frequent

31-61%

O

Occasional

15-30%

I

Infrequent

11-15%

R

Rare-Never

0-10%

 

  1. Intensity Codes (Lifting/Carrying) - Defined as the level of importance of this particular requirement.  Used more often in lifting or carrying section.  Use one of the following letters S, L, M, H, or V.

     

S

Sedentary

Sitting up to 6 hrs./8 hr. day; lifting up to 10lbs occasionally

L

Light

Standing up to 6 hrs./8 hr. day; lifting 20lbs occasionally, lift/carry up to 10lbs frequently;

M

Medium

Standing up to 6 hrs./8 hr. day; lifting 50lbs occasionally, lift/carry up to 25lbs frequently

H

Heavy

Standing up to 6 hrs./8 hr. day; lifting 100lbs occasionally, lift/carry up to 50lbs frequently

V

Very Heavy

Standing up to 6 hrs./8 hr. day; lifting in excess of 100lbs; lift/carry 50lbs frequently

 

  1. Intensity Codes (Push/Pull Forces) - Defined as the level of importance of this particular requirement.  Used more often in determining push/pull abilities.  Use one of the following letters L, M, or H.

     

L

Light

0-25 lbs.; frequent push/pull up to 15 lbs.

M

Medium

26-50 lbs.; frequent push/pull up to 40 lbs.

H

Heavy

51-100 lbs.; frequent push/pull up to 80 lbs.

 

 

Physical Requirements

1 - Work Level

(C, F, O, I, or R)

2 - Intensity Code

Lifting / Carrying

(S, L, M, H, or V)

3 - Intensity Code

Push / Pull

(L, M, or H)

Sitting

c

 

 

Standing with little movement

F

 

 

Walking

C

 

 

Hearing

C

 

 

Talking

C

 

 

Lifting objects up to waist

O

L

 

Lifting objects overhead

O

L

 

Carrying objects

O

L

 

Pushing/pulling objects

O

L

L

Filing

O

 

 

Finger dexterity/handling/ feeling

C

 

 

Typing/keying data

C

 

 

Eye-hand coordination

C

 

 

Near vision

O

 

 

Color vision

O

 

 

Far vision

C

 

 

Night vision

R

 

 

Driving

R

 

 

Reaching

O

 

 

Ascending/descending stairs

O

 

 

Climbing/balancing

O

 

 

Bending/stooping

O

 

 

Kneeling/crouching/crawling

O

 

 

Others, please list:

NA

NA

NA

 

 

 

 

 

Mental Requirements

1 - Work Level (C, F, O, I, or R)

Writing

C

Spelling

C

Reading

C

Remembering

C

Recognition/identification

C

Understanding instructions, information and/or concepts

C

Math Skills

F

Analysis of information

C

Problem Solving

C

Communicating instructions, information and/or concepts

C

Decision making

C

Learning new tasks

C

Drawing

I

Originality/creativity

C

 

 

 

 

Working Conditions (Environment)

Place an (X) if these apply to the position

Normal office environment

X

Patient Care areas

X

Medical (non-patient) areas

X

Alone in department or shift

X

Low lighting

 

Low ventilation

 

Tight work space

 

Potential exposure to disease

 

Potential exposure to chemicals

 

High noise levels

 

Potential electrical hazards

 

Potential mechanical hazards

 

Potentially dangerous equipment

 

Wet environment

 

Heights

 

Outdoors

 

Potential exposure to dust/dirt

X

Other possible safety risks, please list:

NONE

  • OSHA Training for TB

X

  • OSHA Training for Bloodborne Pathogens

X

 

 

 

 

Work Schedule

Place an (X) if these apply to the position

Varying shifts

X

Overtime work

R

Weekend work

F

On-Call work

R

Travel

R

Others, please list:

 

   Holidays

F

 

 

 

 

Work Demands

Place an (X) if these apply to the position

Handles highly confidential data

X

Productivity demands (identified)

X

Accuracy demands (identified)

X

Extended visual concentration

 

Others, please list:

NONE

Tools, Equipment Used:

 

Please list:

Computer/Phones

 

 

 

 

 

 

RN Care Coord Inpt-Edgewood Care Coordination- Part-time, 20 hours weekly

Part time
Edgewood, KY

Published on 03/28/2020