RN - Clinical Care Coordinator

About the Role

Evaluates and assesses patients admitted to the Hospital.

Responsibilities

• Performs concurrent review on all patients and shares all problematic cases with the Supervisor and Physician Advisor.
• Determines and makes appropriate referrals concerning alternate level of care.
• Processes adverse determination decisions to Physician Advisor and distributes notification, as appropriate.
• Identifies problematic care patterns or cases and makes referrals to the Supervisor and the department involved.
• Performs retrospective reviews as required.
• Participates in the maintenance of Utilization Management, Discharge Planning, and Case Management statistics as required.
• Keeps abreast of all changes in policies and procedures relating to Utilization Management, Discharge Planning, and Case Management process.
• Attends Utilization Management Committee and other staff meetings, as required.
• Participates, as required, in ALC meetings.
• Participates in Interdisciplinary Patient Care Rounds.
• Identifies services or treatments that may not be medically necessary and makes referrals to the Physician Advisor.
• Consults with physicians and other health care professionals on aspects of patient care.
• Makes referrals to other hospital departments for collaboration and assistance in discharge planning.
• Implements a discharge plan as necessary; documents ongoing discharge planning activities in the patient's medical record according to protocol.
• Schedules family/patient conferences with the interdisciplinary team, as needed, to assist in coordinating a safe and timely discharge plan.
• Collaborates with appropriate professional personnel to assess patients for alternative level of care and notifies appropriate hospital departments.
• Refers patients who require institutional placement to the Social Work Department for follow-up and action.
• Acts as a liaison with patients' insurance carrier (case manager, utilization reviewer) to coordinate post-hospital services and referrals.
• Makes arrangements for non-North Shore-Long Island Jewish Home Care services including home care, Hospice, equipment, supplies, and laboratory services for post-discharge needs.
• Arranges for patients' post-hospital needs, such as visiting nurse, physical therapy, medical/social model day care, personal care aides, Long Term Home Health Care Programs, home health aides, private hire, DME (equipment, supplies, and respiratory needs).
• Assists in identifying patient incidents through the NYPORTS program.
• Performs Clinical Care Coordination assessment within 72 hours of admission on all patients. Performs ongoing reviews every 48 hours or as necessary.
• Communicates with physicians to ascertain clarification of documentation to justify severity of illness, intensity of service, and quality of patient care.
• Keeps abreast of all changes in Medicare/Medicaid/Commercial Insurances as it relates to the clinical documentation process, the utilization management process, and the case management process.
• Shares all problematic cases with the Supervisor of CM-CCC.
• Identifies problematic documentation patterns or cases and makes referrals to the appropriate departments, to the Supervisor of CM-CCC, and/or the Physician Advisor.
• Performs any and all related duties.

Qualifications

• High School Diploma or equivalent, required.
• Bachelor's Degree in Nursing or related field, preferred.
• Current license to practice as a Registered Professional Nurse in New York State.
• Minimum of two (2) years medical/surgical experience in an acute-care hospital.
• Experience in utilization management/discharge planning, preferred.