RN Care Coordinator, Case Management, 32-Hours, Days, Rotational weekend coverage

Heywood Hospital•Gardner, MA

4d•$40 - $79•Onsite

About The Position

Heywood Healthcare values its employees and offers competitive wages, great benefits, and generous earned time off. This 32-hour per week position is for a Day Shift RN Care Coordinator with rotational weekend coverage, focusing on Case Management. The role involves ensuring efficient and cost-effective patient care through utilization management, discharge planning, and collaboration with multidisciplinary teams.

Requirements

Current Massachusetts Registered Nurse License
Previous UR/QA experience required
Proficient computer skills required
Must have effective written, verbal and interpersonal communication skills
Excellent critical thinking
Ability to multitask and flexibility essential
Discharge planning experience as it pertains to the care transitions, referral process, patient preference/choice services, patient & family satisfaction, post discharge follow-up etc.

Nice To Haves

BSN preferred
2 years of healthcare experience within the Acute Care, SNF, HHA, Behavioral Health and/or Insurance Industry preferred
Interqual experience or equivalent preferred
Meditech Expanse experience preferred

Responsibilities

Conducting utilization reviews and managing care transitions and coordination.
Providing clinical information to payers, monitoring length of stay, and seeking necessary care authorizations.
Appealing denials in a timely fashion.
Reviewing all new admissions and Observation patients within 24 hours of admission against High Risk Screening Criteria and documenting outcomes.
Completing assessments on re-admissions within 30 days, including reasoning for re-admission, documenting findings, and providing data for stratification.
Following up on lack of documentation for medical necessity, supporting documentation with discipline identified.
Tracking and trending opportunities for improvement resulting in late Insurance Reviews and longer lengths of stay.
Educating providers on Interqual Criteria used for determining Admission or Observation status.
Completing utilization reviews daily and/or as required by insurer (concurrent and retro) for medical and/or psychiatric appropriateness according to Hospital's approved criteria.
Assessing, intervening, evaluating, and determining the level of care to establish accurate admission and/or observation status.
Demonstrating basic knowledge of DRG reimbursement, evidenced by standardized measures for length of stay and acuity level status designation.
Demonstrating clinical expertise specific to the issuance of ABN/HINN notice to patients and/or legal significant other and care progression.
Keeping physician and team informed of status change and documenting status.
Providing education and information to patient, family, and care providers regarding continuing care, care management, LOS, re-hospitalization, and disease management.
Participating in discharge planning rounds daily.
Working collaboratively with the multidisciplinary team to determine each patient's needs concurrently, including post-acute care when needed.
Addressing LOS issues, appropriate leveling of patient status, potential needs, resources, and referrals for other disciplines.
Reviewing the medical record for abnormal findings, complications, delays, and deviations from expected clinical outcomes.
Reporting findings to the Provider and/or Director to maintain an efficient, cost-effective episode of care for each patient and documenting intervention provided.
Acquiring knowledge to keep up with changes in technology and regulations.
Utilizing knowledge to redesign systems for improving performance.
Continuously prioritizing projects, activities, and tasks to ensure deadlines and customer needs are met.
Assisting with the preparation of reports/statistics pertaining to staff-specific workflow.
Completing assessment of denial within 1 week providing supporting documentation with outcome of review.
Documenting intervention in the UR EMR section.
Preparing written appeal letters, termination letters, discharge notices, MOON, and IMs when appropriate as per regulatory standards and department policies.
Reporting any variances and trends to the director.
Submitting denials/appeals when completed to the department secretary for processing.
Building rapport and responding to the needs of physicians, reviewers for managed care plans, healthcare team members, 3rd party payers, outside reviewers, and vendors to enhance internal and external customer service satisfaction.
Completing nursing sections of the SNF Level of Care forms for Mass Health patients in need of SNF placement, timely and efficiently, and other forms assisting in transition of care as identified.
Collaborating with the social worker.
Completing discharge planning assessments timely, efficiently, and completely following regulatory standards and departmental policies, assuring appropriate patient flow.
Appropriately leveling patients for home discharge with or without services or to another type of facility such as a SNF, Acute Rehab, etc.
Developing, coordinating, and implementing discharge plans on assigned cases with the patient and/or family/significant other caregiver.
Identifying patient preference and selection choice for HHA/SNF placements, having the patient preference form checked off and signed/dated by the patient and/or significant other.
Notifying the provider when a plan is in place and establishing and determining anticipated readiness for discharge.
Keeping the patient/family/significant other informed and documenting such in the EMR.
Closing cases using appropriate forms for transition of care communication timely and efficiently.
Collaborating with the team to assist the Multidisciplinary Team in providing discharge planning activities to assist in expediting a patient’s discharge as part of the care transitions process.
Remaining current and proficient in the discharge planning process in the event coverage is needed.
Performing any and all other duties as assigned by director and/or designee.