RN-Clinic

This position comprehensively plans for targeted patient populations, performs resource management (including denial management, utilization management, access to appropriate levels of care, discharge planning, care facilitation, and referral to other levels of care), and works collaboratively with the multidisciplinary care team to facilitate desired treatment outcomes.

Responsibilities

• Manages all aspects of transition/discharge planning for assigned patients in a timely manner.
• Collaborates with all members of the multidisciplinary team to facilitate the transition/discharge process for designated caseload.
• Monitors patient progress; intervenes as necessary to ensure the plan of care and services are patient-focused, high-quality, efficient, and cost-effective.
• Provides education to staff, physicians, patients, and their families to ensure effective transition planning.
• Meets directly with the patient and/or family to assess needs and develop an individualized transition/discharge plan in collaboration with the physician team.
• Communicates complex family dynamics that may impact patient care and transition/discharge planning to the multidisciplinary team and post-acute providers.
• Initiates and facilitates referrals to post-acute services, including but not limited to: Homecare, Durable Medical Equipment, Hospice Care, Long Term Acute Care Facilities, Acute Rehab Facilities, and Skilled Nursing Facilities.
• Communicates all necessary information regarding the transition/discharge plan to the multidisciplinary team, patient, and family.
• Provides timely and comprehensive documentation of interactions with patients and/or families and all transition/discharge planning activities.
• Assists patients/families with completion of medical power of attorney, health care surrogate, and advanced directives.
• Collaborates for appropriate resource and financial management, including financial assistance coordination/referrals, entitlement program coordination/referrals, or patient benefit coordination.
• Utilizes quality screens in the electronic record to identify potential issues, including avoidable delays and readmissions.
• Completes clinical reviews for patients and applies approved utilization criteria to ensure medical necessity of admissions and continued stays.
• Screens for appropriate authorization and level of care; facilitates covered day reimbursement certification for assigned patients.
• Discusses payor criteria and issues on a case-by-case basis with clinical staff (e.g., Peer-to-Peer) and follows up to resolve problems with payors.
• Educates hospital staff and physicians on payer regulations and managed care principles to prevent denials.
• Fosters the integration of staff and/or students into the healthcare team.
• Completes annual required education related to specialty accreditation as defined by accreditation standards (for facilities with specialty accreditation requirements).

Requirements

• Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC).
• Three (3) years of clinical experience.

Preferred Qualifications

• Bachelor’s degree in Nursing (BSN).

Skills

• Knowledge of patient’s current medical insurance coverage, limitations, and precertification requirements for Durable Medical Equipment (DME), post-acute placements, infusions, transfers, etc.
• Knowledge of relevant scientific principles, established standards of care, and/or research findings.
• Knowledge of procedures and techniques involved in administering routine and special treatments to patients.
• Knowledge of and appropriate application of the nursing process.

Physical Requirements

• Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping, and feeling.
• Must be able to lift, move, and position patients of all weights, with varying amounts of assistance, on a regular and recurring basis.
• Hearing within a normal range (e.g., to assess breath sounds, heart sounds, apical pulse, monitors, etc.).
• Visual acuity must be within normal range.
• Must be able to perform night driving as necessary for patient care.
• Must be able to perform heavy work; exerting in excess of 100 pounds of force occasionally, and/or up to 50 pounds of force frequently, and/or up to 20 pounds of force constantly to move objects.

Working Environment

• Working closely with others.
• Working protracted or irregular hours.
• Working around biohazards and infectious diseases.
• Working with hands in water.
• Working with electrical hazards associated with patient care equipment.

Schedule

Scheduled Weekly Hours: 40

Shift: Exempt