Title: Coordinator, Inpt Care RN SNF Hsp
Location: Brooklyn Heights, OH
Includes on site and/or telephonic review and coordination of care for Kaiser Permanente members located in Acute Care, Rehabilitation, and Skilled Nursing Facilities.
Essential Functions:
- One of 11 Inpatient Care Coordinators managing an average SNF census of 25 members per day &/or Inpatient hospital census of 1 to 40 members
- Licensed Personnel (Registered Nurse & Licensed Practical Nurse): provides care to patients according to the rules & laws promulgated by the Ohio Board of Nursing & as articulated in the Ohio Administrative & Revised Codes
- Is accountable for maintaining all required licensure, certification & department/ position specific competencies
- Makes clinical decisions & applies critical thinking while reviewing member's medical record to promote continuity & appropriate level of care for referrals for Inpatient, SNF, & outpatient care
- Works collaboratively w/ physician staff
- Interprets & applies appropriate clinical criteria (InterQual, Milliman Care Guidelines, Medicare, & internally developed criteria) based on individual needs of member, clinical information, & assessment of local delivery system & makes decisions or involves physicians or other disciplines to determine appropriate level of care for coordination across the continuum of care
- Monitors State & Federal Regulation compliance in contracted facilities
- Acts as a resource for interpreting clinical scenarios & provide benefit interpretation as it applies to those clinical scenarios, facilitate patient education regarding disease process & follow-up
- Makes follow up appointments & referrals for post discharge care
- Initiates &/or participates in member/family conferences to update member's status w/ member/family to plan for continuum of care
Qualifications:
Basic Qualifications:
- Minimum of 3-5 years experience in Medical Surgical Nursing
- Proven experience in utilizing operational reports (financial, customer satisfaction, clinical)
- Bachelors of Science Degree in Nursing or equivalent in education & experience
- Current RN licensure in the State of Ohio
- Current BCLS certification per American Heart Association guidelines;
- Valid Ohio Drivers License
- Demonstrated competency in adult teaching/learning principles
- Demonstrated competency in word processing functions
- General knowledge base of community based resource
- History of working successfully w/ physicians & other members of the health care team w/out direct supervision.
- Ability to function w/ minimal direct supervision, demonstrate high standards of professional conduct, develop positive working relationships, encourage open communications, demonstrate strong interpersonal skills
- Adheres to HIPPA standards
Preferred Qualifications:
- Two years experience in a Managed Care Organization preferred
- Previous experience in case management,SNF, or discharge planning preferred
- Previous experience working w/ nationally accepted UM criteria & Medicare standards preferred
- Masters Degree preferred
