Registered Nurse - Care Coordinator - Care Management

Parkland Health

7d•Onsite

About The Position

The Registered Nurse - Care Coordinator establishes and maintains an efficient, cost-effective care management process. The role determines patients’ financial and medical eligibility and medical necessity, and develops, implements, and monitors individual plans of care. The coordinator communicates these plans to patients, families, and Parkland staff to support quality care throughout the healthcare continuum and compliance with program and Parkland policies and procedures. The position also maintains the knowledge and skills required for utilization review, care coordination, performance improvement, and professional licensure and certification. The position is onsite, full-time, and scheduled for days, 8:00 a.m. to 4:30 p.m. The coordinator assesses patients, collaborates with multidisciplinary teams, manages utilization review and reimbursement-related coordination, supports patient transitions, monitors outcomes and resource use, and helps identify and implement improvements in care delivery.

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 Texas Nursing Practice Act, established protocols, the multidisciplinary plan of care, and clinical-area-specific standards.
Communicate and collaborate effectively with diverse patients, families, and healthcare staff.
Working knowledge of relevant patient populations and disease processes affecting them.
Working knowledge of PC operations and word-processing software in a Windows environment.
Working knowledge of laws and regulations governing Medicare, Medicaid, and community-based funding sources.
Self-directed, with priority-setting and problem-solving abilities.
Demonstrate patient-centered and patient-valued behaviors.

Nice To Haves

Nursing experience in the assigned clinical area.

Responsibilities

Assess patients on the assigned Care Coordination team and develop case management plans of care using information from patients, physicians, and other members of the healthcare team.
Determine patients’ funding sources and potential eligibility when appropriate; set objectives, goals, and actions to address needs identified through assessment.
Use hospital-approved review criteria to ensure appropriate bed status, identify at-risk populations using approved screening tools, follow reporting procedures, and ensure appropriate admission status is documented.
Collaborate with the multidisciplinary team and patient to implement the plan of care, monitor progress, and intervene as needed to promote patient-focused, high-quality, efficient, and cost-effective services.
Communicate financial counseling as appropriate; address system barriers to diagnostic or treatment progress; and proactively identify and resolve delays and obstacles to discharge.
Ensure plan consensus among the patient or family, physician, and payer; advocate for coverage of needed community services; and coordinate resources and the healthcare team to support transitions to the appropriate next level of care.
Communicate the plan of care and updates to patients and families, reassess its effectiveness, complete care coordination documentation, and work with nursing and other disciplines to ensure discharge needs, including teaching, are met.
Collaborate with the healthcare team to identify best practices for patient outcomes and develop reporting mechanisms to communicate outcomes to physicians and other team members.
Perform utilization management activities for assigned patients by applying approved criteria, monitoring admission and continued-stay appropriateness, and documenting findings according to department standards.
Monitor length of stay and ancillary resource use, taking action to support continuous improvement.
Monitor outcome variances, identify their causes, and implement actions to improve them.
Seek efficient, cost-effective ways to provide appropriate care and support cost-containment efforts by recommending performance improvement opportunities to the healthcare team.
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 as needed.
Transition patients through the healthcare system according to individual and population needs, directing liaison activities that integrate patients into the continuum of care, including services, health promotion and counseling, disease prevention, health education and screening, and community resource linkage.
Participate in special projects and serve on committees as assigned.