Registered Nurse - Care Coordinator - Care Management

Parkland Health

7d•Onsite

About The Position

Establishes and maintains an efficient, cost-effective care management process by determining patients’ financial and medical eligibility and medical necessity, and by developing, implementing, and monitoring individual plans of care. Communicates plans to patients, families, and Parkland staff to support quality care throughout the healthcare continuum and compliance with program and Parkland policies and procedures. Maintains knowledge and skills related to utilization review, care coordination, performance improvement, and professional licensure and certification. The position conducts patient assessments, develops and monitors case management plans, coordinates services and transitions, performs utilization management, and works with multidisciplinary teams, patients, families, and payers to support effective and appropriate care. It is onsite, full-time, and works a Monday–Friday, eight-hour day shift.

Requirements

Graduate of an accredited school of Nursing.
Two years of hospital or community-based patient care nursing experience; experience in the assigned clinical area is preferred.
Current, valid RN license or temporary RN license from the Texas Board of Nursing, or a valid Compact RN license.
Current healthcare provider BLS for Healthcare Providers certification from the American Heart Association, American Red Cross, or Military Training Network.
Provide care in accordance with the current State of Texas Nursing Practice Act, established protocols, multidisciplinary plans of care, and clinical-area standards.
Communicate and collaborate effectively with diverse patients, families, and healthcare staff.
Demonstrate working knowledge of specific patient populations and the disease processes affecting them.
Demonstrate working knowledge of PC operations and word-processing software in a Windows environment.
Demonstrate working knowledge of laws and regulations governing Medicare, Medicaid, and community-based funding sources.
Be self-directed and capable of priority setting and problem solving.
Demonstrate patient-centered and patient-valued behaviors.

Nice To Haves

Nursing experience in the assigned clinical area.

Responsibilities

Assess assigned patients and develop case management plans using information from patients, physicians, and other members of the healthcare team.
Determine patient funding sources and potential eligibility, and develop objectives, goals, and actions to address assessed needs.
Use hospital-approved review criteria to determine appropriate bed status, identify at-risk populations, follow screening and reporting procedures, and ensure admission status is documented.
Collaborate with the multidisciplinary team and patient to implement the plan of care; monitor progress and intervene as needed to support patient-focused, high-quality, efficient, cost-effective services.
Communicate financial counseling information as appropriate and address system barriers affecting diagnostic or treatment progress.
Identify and resolve discharge delays and obstacles; maintain plan consensus among the patient or family, physician, and payer.
Advocate for coverage of needed community services, mobilize resources, and coordinate transitions to the appropriate next level of care.
Communicate and update the plan of care with patients and families, reassess its effectiveness, complete required care coordination documentation, and work with nursing and other disciplines to meet discharge needs, including teaching.
Collaborate with the healthcare team to identify best practices for patient outcomes and develop mechanisms for reporting outcomes to physicians and other team members.
Perform utilization management for assigned patients by applying approved criteria, monitoring and documenting admission and continued-stay appropriateness, and monitoring length of stay and ancillary resource use.
Monitor outcome variances, identify causes, and implement actions to improve outcomes.
Recommend performance improvement opportunities and support cost-containment efforts.
Coordinate with the Care Management team on covered-day reimbursement certification or authorization; discuss payer criteria and issues with clinical staff and follow up to resolve payer problems.
Coordinate patient transitions based on individual and population needs, including services, health promotion and counseling, disease prevention, health education and screening, and community resource linkage.
Participate in special projects and committees as assigned.