RN Care Coordinator

4 weeks ago


Clackamas, United States Kaiser Permanente Full time
div> Job Summary:

Inpatient Care Managers are Registered Nurses who independently assure patients are admitted to the correct level of care for accurate billing and reimbursement, provide quality, cost effective clinical coordination/care management in acute care and emergency care settings, manage patients with routine and complex transition planning needs by independently assessing needs, developing, and implementing plans of care for transitions across care settings. Inpatient Care Manager also serve as expert consultants and educators for physicians and other health care team members for discharge and transitional care, coordination of internal and community resources, and support the evaluation and improvement of systems of care to support the optimal utilization of health care resources, while maintaining quality of patient care. The Inpatient Care Manager assumes primary accountability for anticipating, assessing, developing, implementing, documenting, advising, and communicating a safe transition plan of care for patients with complex care needs./>

Coordinates post-discharge patient care needs to assure the timely and effective discharge of routine and complex patients from the hospital setting.
Independently and proactively completes and documents patient assessments which are thorough, timely, age appropriate, and reflect psychosocial support systems, care needs, health plan benefits, level of care determinations for hospitalized patients.
Coordinates and communicates with patients, families, and the health care team to develop mutually agreeable plans of care that optimize the use of resources to support the particular needs of individual patients.
Facilitates resolution of issues which present barriers to safe transfers through the use of patient/team care conferences to assure the efficient transition to a lower level of care and to assure the patient/family receives the right care at the right time so that quality and utilization of resources are simultaneously enhanced.
Ensures systematic and ongoing contact with interdisciplinary staff and continuing care services to assure the safe transition of patients across care settings.
In collaboration with the interdisciplinary health care team, ensures regulatory and compliance standards are met.
Med/Surg (hospital acute care)
ICU (hospital acute care)
Emergency Department
Home Health
Skilled Nursing Facilities
Hospice
Long Term Acute Care
Inpatient Rehab
Utilization Management


Education


License, Certification, Registration
Demonstrated ability to interrelate with physicians, nurses, support staff, and patients in interdisciplinary approach.
Familiar with care process related to discharge and transitional facilities and services.
Thorough knowledge of principles of teaching and delegation, assessment skills and care planning, and appropriate
utilization of acute hospital, long-term care, and home care resources.
Able to develop concise and thorough documentation of patient clinical assessment and care needs.
Ability to effectively provide culturally competent care./>Knowledge of appropriate utilization of acute hospital and Kaiser Permanente internal resources.
Knowledge of Medicare and Medicaid regulations related to eligibility requirements: hospital, nursing facilities, home
health, hospice, and Durable Medical Equipment (DME).
Knowledge of principles of patient teaching, disease prevention measures, and physical assessment as it relates to the
needs of patient and the next level of care.
BSN or bachelors degree and MSN.
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