Care Management Coord-RN

TriHealth • Cincinnati, OH

3d

About The Position

Care Management Job Overview: The Care Management Coordinator is responsible for overseeing the processes and documentation that occur as evidence based practice is applied at the bedside. Directs and or completes all functions of the government and commercial utilization management process. Assesses and coordinates implementation of the discharge plan. Collaborates with the multidisciplinary team to assure effective, efficient, appropriate care in order to optimize the health status and assure a smooth transition between levels of care for patients served. Performs utilization review for patients served. Requires weekend, holiday, and off site commitment, with the exception of Hospice of Cincinnati. The TriHealth Nursing Vision, Mission, and Philosophy speaks to professional development, collaboration, and our nursing culture. To achieve excellence in nursing care, TriHealth encourages: pursuit of improved knowledge through continuing education classes, formal education leading to advanced degrees, and the attainment of specialty certification; nurse membership in local, regional, and national nursing organizations related to the appropriate nurse specialty; involvement in activities that better the health of our community; nursing research activities and use of evidence-based practice, and all nurses to foster, support, and personally model collaborative relationships amongst nurses, physicians, and other caregivers for the betterment of patient care.

Requirements

• Associate's Degree or Diploma in Nursing
• Hires into position (internal and external) required to obtain BSN within 5 years of hire
• BLS/CPR (Basic Life Support for Healthcare Providers)
• Registered Nurse
• Excellent communication skills
• Ability to negotiate
• Problem solve
• Establish effective working relationship with members of the healthcare team and external customers
• Knowledge & experience in computer key boarding
• 3-4 years experience Clinical in Nursing

Nice To Haves

• Professional organization membership preferred

Responsibilities

• Using current practice guidelines, assesses all patients, evaluating progress toward clinical goals and next level of care. Reassesses as clinical condition changes.
• Complete initial utilization review using Interqual criteria.
• Take follow up action to resolve the situation when criteria are not met by implementing and documenting according to the Utilization Review plan.
• Coordinate the development of a comprehensive plan of care through patient/family involvement in an interdisciplinary team process.
• Ensure the patient's health care goals are met related to evidenced based quality care.
• Ensure that all commercial and government payment requirements are met for continued stay reviews, and other conditions of participation.
• Ensure that CMS requirements are met for patient status.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 5,001-10,000 employees