Job Posting
Care Coordinator & Case Manager/Utilization Review (1/2 time in each role) - Acute Care
The RN Care Coordinator is responsible for assessing, planning, facilitating and advocating for options and services through a continuum of care from point of contact through discharge on assigned patients. This role in such a manner has to meet the individual’s health needs while promoting quality and cost- effective outcomes. The position emphasis will be on care coordination, communication and collaboration with nursing, physicians, departments within the medical center, insurers and post- acute service providers to pace the care toward optimal outcomes within the appropriate level of care. The RN Care Coordinator will advocate for the patient and family by identifying and valuing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions. In addition, the RN Care Coordinator will consistently conduct the utilization review process and be responsible for building SLHD’s swing bed program.
Desired Education, Certifications and/or Experience
Required
· Current Wyoming RN License
Preferred
· BSN degree in related healthcare field or experience equivalent
· Minimum of 3 years of nursing experience in acute hospital setting
· Minimum of 3 years of experience in Discharge Planning, Utilization Review, and general care coordination
· Prior Care Coordination experience in acute hospital clinical or insurance setting
· Case Management Certification preferred.
Responsibilities / Functional Job Description
General: Performance Expectations
1. Responsible - works independently, in a safe and appropriate manner. Demonstrates both problem-solving and
problem-prevention skills.
2. Sensitive - displays sensitivity to the needs of patients and co-workers. Demonstrates good communications skills and
empathy.
3. Timely - recognizes time as a customer's most valuable resource and responds promptly to patients' and co-workers'
needs.
4. Accurate - works carefully and precisely, with attention to detail.
5. Coordinated - organizes and delivers service in the proper order. Displays good organization skills and utilizes
resources wisely.
6. Thorough - meets all the requirements of his/her position. Is able to evaluate and follow up on his/her services.
General: Standards of Behavior
1. Demonstrates a commitment to living the SLHD standards of behavior through exemplifying in action, a commitment to the values of SLHD, namely:
A. Innovation – continually seeking the latest advances in cost effective healthcare and customer service.
B. Compassion – concern for the individual, empathy for the situation, action to provide service
C. Integrity – doing the right thing; always.
D. Community – supporting, giving and acting to improve where we live, serve, and work.
E. Passion for Healthcare – fervently, avidly, and zealously seeking the improvement of human health
2. Displays this commitment to the standards of behavior through actions and words, by demonstrating the following behavior traits:
A. Adaptability – Responding resourcefully to changes indirection, priorities, schedules, approaches and responsibilities for the good of everyone. Maintaining a positive attitude when faced with a difficult or challenging situation and providing an uplifting and realistic outlook on the opportunities the future may present.
B. Communication – Listening attentively and seeking clarification, being friendly in words and actions, responding to others in a timely manner to ensure satisfaction, comfort and quality care. Utilizing AIDET and the promise to explain the experience the patient can expect, and communicate how the patient will receive excellent and timely care.
C. Professional Conduct and Attitude- Keeping personal conversations to an appropriate volume for the area I am working in, treating everyone in a courteous manner – rudeness is never acceptable, addressing conflict with others privately and respectfully and utilizing the appropriate chain of command. Doing the right thing, even when no one is watching, keeping frustration separate from patent care and professional activities, and recognize that patients are not an interruption, they are our reason for being here.
D. Commitment to Team Members/Patients – Assist patients in finding their destinations, walking with them when possible, interacting constructively with team members and supporting a blame free environment, recognizing there is no place for “it’s not my job”, finding the right person to support a patient or coworker if I am unable to support or help them. I will not spread negativity, being positive starts with me.
E. Personal and Career Development – Demonstrating a curiosity toward learning and practicing self-development. Supporting co-workers by sharing knowledge, expertise and encouragement to help them be successful in their role. Finding ways to improve the quality of my work even when things are going well. Seeking creative solutions to problems and encouraging creativity in others.
F. Sense of Ownership – Admitting and correcting mistakes, taking personal responsibility to help the organization to succeed. Ensuring cleanliness by maintaining a clutter free environment. Refraining from behavior or conversations that undermine the confidence of the community in our facility. Utilizing resources effectively and maintaining financial responsibility.
Role Specific: Acute Care Coordinator/Utilization Review Work role responsibilities
1. Function in an interdependent role under the direction of the Nursing Services Director, a physician, or physician assistant.
2. Has major responsibility for assessing, planning, implementing, and evaluating quality patient care which is consistent with the establishing SLHD’s swing bed program.
3. Is responsible for documenting all prior authorization information including approval dates, billing units, procedure and prior authorization number.
4. Responsible for initiating, developing, and coordinating a discharge plan with assigned patients in collaboration with the physician, physician’s assistant and other health care providers.
5. Responsible for maintaining the dignity and confidentiality of the patient and serves as a patient advocate at all times.
6. Is responsible for maintaining an up-to-date knowledge of care trends and new developments in the healthcare field in order to promote optimal standards of care.
7. Utilizes effective human relation and communication skills in interfacing with hospital personnel, patients, and others.
8. Is responsible for making independent nursing decisions relating to patient car discharge plan.
9. Interviews and counsels’ patients, families or significant others for options as related to discharge planning as indicated. Acts as a patient advocate.
10. Evaluates for and initiates referrals to appropriate agencies and interdepartmental services to coordinate swing bed patient census.
11. Includes patient, family, significant others in assisting to establish the discharge plan of care.
12. Is knowledgeable of resource information available and provides information to patients, families, staff, providers, and community. Facilitates communication among all disciplines involved in the provision of care.
13. Maintains current knowledge of Federal and State regulatory guidelines.
14. Reviews patient data a minimum of once daily and as needed.
15. Responsible for updating discharge planning/care coordination/ utilization review policies and procedures annually and as needed.
16. Completes screening tools as indicated to improve quality of care and build swing bed patient program.
17. Maintains current resources and knowledge of durable medical equipment services, rehabilitative options, home care services, swing bed program and long- term care facilities.
18. Participates in community events as appropriate.
19. Actively participates in self-development by attending educational programs offered inside and outside the facility.
20. Contacts insurance companies for prior authorizations and nursing follow up.
21. Provides or arranges for financial counseling as indicated (i.e., HINN letters, BIPA notices, ABN/s payment plans).
22. Ensures continuity of care by communicating appropriate patient information to any health care organization or provider to which the patient is admitted, transferred or discharge.
23. Uses current utilization guidelines/criteria.
24. Coordinates the evaluation of the severity of illness and intensity of service, discharge readiness, outlier and co-morbidity issues.
25. Educates providers and other staff regarding necessary documentation to evidence medical necessity and continuing care plan.
26. Assists with tracking, trending, and displaying utilization data and making recommendations for improvement of swing bed program.
27. Performs other duties as assigned
28. Accountable for cost-effective patient care through monitoring the use of personnel, time supplies, and equipment
a. Attends work in a punctual and dependable manner
b. Manages time and uses supplies based on patient needs and medical/nursing plans of care.
c. Assures that charges are accounted for and are recorded to the patient billing system.
29. Accountable for coordinating patient care activities with patient, colleagues, other hospital personnel, and physicians.
30. Accountable for maintaining patient confidentiality.
a. Communicates effectively with patients and others
b. Understands patient rights and complies with confidentiality policies
c. Functions competently under stress
d. Communicates and solves problems with coworkers, physicians, and other hospital employees.
e. Demonstrates appropriate problem-solving ability and support of hospital philosophy and policies.
31. Performs other duties as assigned
Desired Knowledge, Skills & Abilities
1. Excellent interpersonal skills including persuasion, customer care and service, and conflict resolution.
2. Above average Emotional Intelligence, with the ability to empathize with the emotional experience of others without taking on and agreeing with every communicated perspective.
3. Ability to memorize and coordinate several discrete sets of essential information.
4. Clear and concise communicative style, balancing the need to express complicated content, while, at the same time,
expressing support and understanding.
5. Powerful listening skills including the ability to sort through complex messages, retain the several discrete and related details, and synthesize hierarchal meaning according to what is most important on the part of the person communicating.
6. Ability to follow a script while appropriately improvising and making the required messaging one’s own.
7. Ability to skillfully coordinate competing priorities, ensuring the completion of all required tasks.
8. Skill in accuracy and attention to detail.
9. Knowledge of state and federal regulations, policies, and procedures governing accounting, medical billing and financial recordkeeping.
10. Knowledge of general accounting principles and ability to produce, read and analyze financial reports
11. Knowledge of accounting and finance best practices and programs which enhance the financial success of the organization
12. Knowledge of financial/revenue cycle reporting and key performance indicators for measuring and benchmarking performance
13. Ability to operation various office equipment
14. Skill in accuracy and attention to detail
15. Ability to perform public relations and public speaking in a professional manner
16. Ability to develop strong relationships with team members.
17. Ability to maintain confidentiality.
18. Ability to read, write legibly and calculate mathematical figures.
19. Ability to solve practical problems and deal with a variety of variables.
20. Ability to effectively lead a team a fast paced and intense environment.
21. Ability to handle stressful situations and respond appropriately.
22. Ability to work and interact effectively and positively with other staff members to build and enhance teamwork across SLHD departments.
23. Ability to communicate to complete responsibilities effectively
24. Ability to see to use computer efficiently and read computer reports and correspondence
25. High proficiency with Microsoft office products (excel, word, PowerPoint, etc.)
Equal Employment Opportunity
South Lincoln Hospital District will provide equal opportunity employment to all employees and applicants for employment. No person shall be discriminated against in employment because of race, color, gender, age, national origin, ancestry, religion, physical or intellectual disability, marital status, parental status, sexual orientation or any other category protected by law.
Americans with Disabilities Act (ADA) Statement
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While
performing the duties of this job, the employee is regularly required to stand; sit; use hands to finger, handle, or feel; reach with hands and arms; and talk or hear. The employee is occasionally required to walk; stoop, kneel, or crouch. The employee must regularly lift and/or move up to 50 pounds.
Additional Information
Position Type : Full Time
Contact Information
Stephanie Raver - HR Business Partner
HR
711 Onyx
Kemmerer, WY 83101
Email: sraver@southlincolnmedical.com
Phone: 13078008683 |
