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RN Case Manager
2 months ago
We are seeking a highly skilled and experienced Registered Nurse to join our team as a Clinical Care Coordinator at Norwalk Hospital Association. As a key member of our care coordination team, you will play a vital role in ensuring the seamless transition of patients through the healthcare system.
Key Responsibilities- Coordinate and direct the level of care appropriateness from admission to discharge, utilizing discretion and independent judgment to apply initial screening criteria standards and maintain compliance.
- Prioritize and delegate daily functions to ensure completion of all required tasks, including coordinating ambulance and DME services.
- Complete planning using high-risk admission data and discharge criteria, anticipating medical and psychosocial needs in high-risk patients.
- Manage level of care status throughout the stay by performing continued stay reviews, removing barriers to progression of care, and revising transition plans as needed.
- Ensure all appropriate regulatory documents are provided to patients, including MOON, CT notice, IMM, HINN, and ABN.
- Ensure the completion of a discharge needs assessment and formulation of a plan on all admissions, utilizing resources such as CARL tool for bundled payment cases and Navihealth.
- Act as a clinical role model to the healthcare team, leading and facilitating multidisciplinary rounds to proactively progress patient plans of care and discharge.
- Address readmission prevention strategies and LOS concerns, querying members of the healthcare team to obtain accurate and complete documentation to ensure appropriate clinical documentation.
- Coordinate and collaborate to ensure the implementation of all discharge plans, meeting and acting on cases not meeting admission criteria, and referring to physician advisors all cases requiring immediate review and discussion.
- Proactively interact with third-party payers to prevent denials, acting as a liaison between patients, physicians, family, and healthcare teams regarding plans of care and progress towards goals.
- Provide education to physicians, nurses, and other members of the healthcare team, providing a concise hand-off to colleagues daily.
- Track and trend variance data, elevating concerns and findings to management, complying with all standards and policies regarding safety and patient safety initiatives.
- Fulfill all compliance responsibilities related to the position, performing other duties as assigned.
- Minimum formal education of Associate Degree in Nursing and minimum of three years job-related experience.
- Registered Nurse license State of CT with minimum of one year as an acute Care Coordinator.
- Knowledge and expertise with use of electronic medical record and use of both Interqual and Milliman screening criteria.
- Excellent collaborator and team member who is able to work closely with physicians and all members of the healthcare team to procure the right level of care, correct order for hospitalization, optimal plan of care, and facilitation of services.
- Knowledge and expertise in both CMS and insurance industry standards as well as guidelines pertaining to appropriate coverage notifications.
- Ability to be flexible, resourceful, and creative in problem-solving, with excellent communication skills both oral and written.
- Certification in Case Management preferred or willing to obtain.
- Bachelors Degree in Nursing preferred.
Work will be performed in a hospital setting, with a medium to heavy effort required. May exert up to 35 lbs. force. Generally pleasant working conditions.
Equal Employment OpportunityNorwalk Hospital Association is an equal employment opportunity employer and welcomes applications from diverse candidates. We will endeavor to make a reasonable accommodation to the known physical or mental limitations of a qualified applicant with a disability unless the accommodation would impose an undue hardship on the operation of our business.
