RN Medical Respiratory Care NURSE
2 weeks ago
Kaiser Permanente is seeking a Registered Nurse (RN) Skilled Nursing for a nursing job in Portland, Oregon.
Skilled Nursing
~ Shift: 8 hours, days
~ Employment Type: Staff
Assure timely, appropriate and safe transfer of patients from hospitals, emergency departments, home health/hospice, and outpatient clinics to skilled nursing facilities (SNF) or long term acute care hospitals (LTACH) through a single central placement process. Improve the quality of the hospital to SNF/LTACH transfer process with improved clinical outcomes, patient, clinician and facility satisfaction resulting and efficient use of health care resources. Independently perform ICF utilization reviews and rehabilitation authorizations. Act as an expert resource consultant to staff and clinicians transitioning patients.
Review and evaluate SNF/LTACH referrals using established criteria to assess skilled nursing and rehabilitation needs of referred patients. Provide timely and accurate information to KP Provider Relations staff to obtain appropriate spot contracts non-contract facilities. Document in the electronic medical record and/or in the SNF contact record, information necessary to support assessment and authorization for in and out of area placement and referrals. Track bed availability in contract SNF/LTACHs and assign member to first appropriate available bed. Communicate transfers/admissions/placements to GLTC staff, Care Coordinators and others involved in placement process or requiring information for the purpose of tracking utilization, etc.
Provide member information to SNF/LTACH and problem-solve/facilitate any issues which present a barrier to safe transfers and the provision of quality care, ( e.g. deductible benefit billings, special equipment needs, nursing skills, infusion or parenteral nutrition, incomplete member health information, clinical instability, wound care, respiratory issues, behavioral issues ventilator care, dialysis, interpreter needs or need for additional diagnostic work). Review members pulmonary care needs for SNF/LTACH placement. Assure members meet appropriate regulatory and length of stay guidelines.
Develop and maintain expert level of knowledge and skills related to availability of and criteria for regulatory requirements for um and level of care appeals in various health care settings. Act on behalf of member to ensure they are informed and understand their appeal rights and processes if they disagree with a health care determination. Coordinate member request for appeal according to KP policies and procedures with GLTC, facility and KPNW member relations staff.
Develop and maintain expert level of knowledge and skills related to regulatory requirements for ICF/Medicare Part B criteria and utilization management. Review of ICF records for therapists requesting rehabilitation visits for members. Ensure the number of visits requested reflects appropriate utilization of health care resources. Evaluate if the plan is progressing effectively and efficiently toward resolution or transition to an appropriate level of care.
Participate in continuous quality improvement activities. Ensure systematic and ongoing contact with hospital staff/other Kaiser depts. Provide leadership in SNF/LTACH transitions with regard to policies and procedures related to patient transition across care settings. Facilitate education of health care staff providing transition assistance for patients with complex needs, ensuring they have sufficient knowledge of AFH, ALF, Home Health, Hospice, Medicare/Medicaid skilled SNF/LTACH UM criteria. Ensure that UM and regulatory standards are met in collaboration with others in the interdisciplinary health care team. Participate in quality activities. Assist in analyzing SNF/LTACH process data. Identify and implement process improvements which enhance quality and cost in collaboration/partnership with Care Coordinators, Geriatric Long Term Care team, add SNF/LTACH staff and referral sources. Consult with GLTC staff regarding appeals and utilization concerns. Collects quality assurance data and summarizes findings. Participate in policy and procedure development and revision. Participate in continuing education to incorporate and maintain up to date knowledge and best practices in leading staff involved with transitional care to SNF/LTACH, performing appeals and ICF utilization reviews, etc.
Minimum three (3) years of experience in the area of case management, discharge planning or utilization management.
Bachelors degree in nursing from an accredited school OR four (4) years of experience in a directly related field.
License, Certification, Registration
~ Working knowledge of Medicare and Medicaid regulations for SNF.
Working knowledge of acute, home health/hospice regulations, grievance and case management processes.
Working knowledge of the care of chronically ill and frail elderly and needed community resources.
Working knowledge of palliative care of terminally ill patients.
Minimum two (2) years of experience working in a skilled nursing facility.
Minimum five (5) years of acute care hospital experience.
Minimum four (4) years of UM/QA experience or home health/hospice, care coordination, or discharge /transition planning experience.
Working knowledge of managed care.
Thorough knowledge of Medicare, Medicaid, Nursing facility/LTACH regulations and Health Plan benefits.
Thorough knowledge of quality improvement processes.
Thorough knowledge of appropriate rehabilitation utilization.
Ability to connect with members and staff in a caring, respectful manner.
Ability to respond effectively to help or serve others and meet needs.
Placement Coordinator, Skilled Nursing Facilities / Long Term Acute Care (On Call, Days)
At the heart of health care, you'll find Kaiser Permanente. As the nations leading not-for-profit, integrated health plan, we make a difference in the lives of members, patients, and communities across the country.
Whether you choose to join a hospital in the Northwest, a clinic in Southern California, or a medical office in the Mid-Atlantic, we have many opportunities for you to shape the future of care.
Our teams are empowered to advance impactful and extraordinary care for all by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement. it also reaches far into our communities.
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