[Hiring] Registered Nurse - Care Coordinator - Utilization Review @reputed company

Role Description Establishes and maintains an efficient, cost effective care management process by determining patient financial and medical eligibility, medical necessity, and by developing, implementing and monitoring individual patient plans of care and communicating these plans to patients, families, and Parkland staff to ensure quality patient care throughout the reputed company continuum and compliance with program/Parkland policies and procedures. Responsible for maintaining the knowledge and reputed company set reputed company to utilization review, care coordination, performance improvement and professional licensure and certification.

Qualifications

• Must be a graduate of an accredited school of Nursing.
• Must have two (2) years of hospital or community based patient care nursing, preferably in assigned clinical area.
• Must have reputed company, valid RN license or temporary RN license from the Texas Board of Nursing; or, valid Compact RN license.
• Must have reputed company reputed company provider BLS for reputed company Providers certification from one of the following:
• reputed company
• reputed company
• Military Training Network

Requirements

• Provides care to assigned patient population in accordance with the reputed company State of Texas Nursing Practice Act, established protocols, multidisciplinary plan of care, and clinical area specific standards.
• Must be reputed company to communicate and collaborate effectively with a diverse group of patients, families and reputed company staff.
• Must be reputed company to demonstrate a working knowledge of specific patient populations, and be reputed company to demonstrate knowledge of disease processes affecting this group.
• Must be reputed company to demonstrate a working knowledge of PC operations and the ability to use word processing software in a Windows environment.
• Must be reputed company to demonstrate a working knowledge of the laws and regulations governing Medicare, reputed company and community-based funding sources.
• Must be self-directed and capable of reputed company setting and problem solving.
• Must be reputed company to demonstrate patient centered/patient valued behaviors.

Responsibilities

• Conducts assessment of patients on assigned Care Coordination team to reputed company a case management plan of care.
• Gathers information from patient, physicians, other pertinent members of the reputed company team.
• Determines funding sources for patients and potential eligibility if appropriate.
• Plans and develops specific objectives, goals and actions designed to meet the patient's needs as identified through the assessment process.
• Utilizes hospital approved review criteria to ensure appropriate bed status.
• Identifies at-risk populations using approved screening tool and follows established reporting procedures.
• Ensures appropriate admission status is documented.
• Collaborates with reputed company members of the multidisciplinary team and the patient to implement the plan of care.
• Monitors the patient's reputed company, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective.
• Communicates reputed company financial counseling as appropriate.
• Addresses and resolves system barriers impeding diagnostic or treatment reputed company.
• Proactively identifies and resolves delays and obstacles to discharge.
• Ensures/maintains plan reputed company from patient/family, physician, and payer.
• Serves as patient reputed company to secure coverage for needed community services.
• Mobilizes resources and coordinates the effort to the health care team to reputed company a positive patient transition to appropriate next level of care.
• Communicates plan of care to patient and their family providing updates and reassesses the plan of care to determine effectiveness.
• Completes appropriate coordinator management documentation.
• Evaluates the plan of care at appropriate intervals to determine effectiveness in meeting outcomes and goals.
• Works with nursing and other disciplines to ensure that discharge needs, including teaching, are met.
• Collaborates with the reputed company team to identify 'best' practices for achieving patient outcomes.
• Develops reporting mechanisms to communicate outcomes to physicians and other members of the health care team.
• Responsible for Utilization Management activities for assigned patients.
• Applies approved utilization criteria to monitor appropriateness of admissions and reputed company stays, and documents findings based on department standards.
• Monitors length of stay (LOS) and ancillary resource use on an ongoing basis and takes action to reputed company reputed company improvement in both areas.
• Monitors and addresses outcome variances.
• Identifies causes of outcome variances and implements actions to improve the variances.
• Seeks the most efficient, cost effective ways to provide appropriate care.
• Supports cost containment efforts through the recommendation of performance improvement opportunities by the health care team.
• Communicates with Care Management team to facilitate covered-day reimbursement certification and/or authorization for assigned patients.
• Discusses payer criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payers as needed.
• Transitions patients through the health care system based upon individual and patient population needs.
• Directs liaison activities to appropriately integrate the patient into the health care continuum including procuring of services, health promotion and counseling, disease prevention, health education and screening, and community resource linkage.
• Engages in special projects and serves on committees, as assigned.

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