Registered Nurse Care Coordinator
2 weeks ago
The RN Case Manager is responsible for conducting a thorough initial assessment upon patient admission, following the protocols established by the Care Management Department. This role involves screening patients using recognized tools to identify high-risk indicators, ensuring that vulnerable patient groups receive the necessary support services for a successful discharge and to mitigate the risk of readmission. Continuous reassessment of patient needs throughout their hospital stay is a critical component of this position.
Key Responsibilities:- Adhere to the Hospital's Performance Standards, Policies, and Behaviors.
- Conduct comprehensive initial assessments for all patients.
- Facilitate multidisciplinary care coordination both within the hospital and with external facilities.
- Manage transitional planning activities, which include:
- Educating patients and caregivers.
- Coordinating aftercare arrangements.
- Engaging with commercial payers.
- Identifying root causes for high-utilization patients.
- Commercial payer evaluations.
- Determining patient disposition.
- Conducting retro/self-audits.
- Managing medical necessity variances.
- Performing clinical reviews for admissions.
- Bachelor's degree in Nursing (BSN) or a related field is required.
- A minimum of 5 years of clinical experience in emergency, critical care, or medical/surgical settings is essential.
- Prior experience in case management is preferred.
- Familiarity with healthcare financial, regulatory, and payer issues is advantageous.
- Knowledge of state, local, and federal healthcare programs is strongly preferred.
- Experience with Milliman/InterQual criteria is beneficial.
- A valid Registered Nurse (RN) license in New York State is mandatory.
- Certification in PRI/Screen is highly preferred.
- Certification as a Certified Case Manager (C.C.M.) is desirable.
- Proficient computer skills are essential.
- Ability to establish effective two-way communication by clearly defining expectations and actively listening to concerns.
- Skill in delegating responsibilities appropriately.
- Capacity to maintain composure under pressure and manage multiple tasks simultaneously.
- Potential exposure to chemicals necessary for job functions, with access to safety data sheets available through the hospital's resources.
- Physical ability to walk, stand, and sit for extended periods, along with the capability to carry necessary equipment during rounds.
- Ability to perform complex manipulative tasks and meet all regulatory requirements.
- Strong analytical skills to deconstruct multifaceted problems and prioritize tasks effectively.
- Visual and auditory capabilities to communicate effectively in various environments.
This role encompasses a diverse range of patient demographics, including:
- Neonates (birth – 28 days)
- Patients with unique communication needs
- Infants (29 days – less than 1 year)
- Patients with developmental delays
- Pediatrics (1 – 12 years)
- Patients at end of life
- Adolescents (13 – 17 years)
- Patients under isolation precautions
- Adults (18 – 64 years)
- Patients with cultural needs
- Geriatrics (65 years and older)
The responsibilities outlined in this job description are not exhaustive and may evolve based on the needs of the organization.
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