UnityPoint Health RN Care Manager in Waterloo, Iowa
Serves an integral role in the multidisciplinary effort to identify and deliver quality and cost-efficient healthcare to patients. While the role is multifaceted, teams with social services in guiding concentrated efforts to the oversight and collaborative coordination of care and services for a defined patient population, ensuring that adequate discharge plans are in place and completing utilization management and quality review activities. Care is provided through a therapeutic relationship with the patient and family. Utilizes evidence-driven protocols to assure reliable and consistent care. Collaborates with members of the interdisciplinary team to achieve department and hospital goals related to coordination of care, reducing avoidable admissions and ensuring appropriate level of care.
Assumes responsibility for developing a plan of care including a discharge plan that is mutually established with the patient and family, with identified goals and expectations reviewed to identify and verify priorities.
Facilitates communication with provider and healthcare team regarding current level of care status, plan of care, focus goals, progress towards goals and anticipated discharge needs.
Facilitates communication with patient and family regarding current level of care status, expected length of stay, plan of care, focus goals, progress towards goals and anticipated discharge needs.
Provides explanations to patients and families regarding level of care status and implications of observation status versus inpatient status, as appropriate.
Recognizes potential and actual post-discharge needs and makes appropriate referrals to social work to enhance continuity of care. Assists in arranging post-discharge services, including contact with insurance company for possible pre-authorization requirements.
Coordinates discharge plan with provider, social services, healthcare team, patient and family.
Communicates the discharge plan to the primary nurse and healthcare team through verbal updates and handoff tools.
Completes discharge planning documentation in the electronic medical record. Helps with coordinating placement with Medicare Nex Generation patients and following Millennium Care Guidelines criteria for length of stay.
Provides oversight for utilization of evidence-based care for patient populations.
Assesses need for patient and family education. Participates with the healthcare team in identifying and providing health teaching and counseling, as appropriate. Facilitates referrals to appropriate resources.
Multidisciplinary patient care charting is done concurrently as care is provided to assure that goals of care and discharge planning activities are concurrently accessible to the healthcare team.
Maintains knowledge of utilization management criteria and communicates with Utilization Review Assistant to ensure medical necessity and appropriate patient class for hospital stay.
Assesses patient for Level of Care. Performs initial screening review for level of care in Interqual to determine if patient meets admission criteria.
Ensures that ordered diagnostic tests, procedures and treatments are pre-authorized based on payer requirements and scheduling is coordinated for efficiency.
Provides level of care and length of stay coaching and guidance to providers in all health care settings.
Collaborates with the multidisciplinary healthcare team to ensure the delivery of high quality, evidence-based care.
Collaborates closely with Social Services to facilitate discharge planning activities.
Completion of an accredited nursing program. Baccalaureate degree in nursing preferred.
Two years of registered nurse experience. Three years’ experience in a clinical setting preferred with recognized knowledge and expertise in caring for specific patient populations preferred.
Current Iowa nursing licensure.
Valid driver’s license when driving any vehicle for work-related reasons.
Must be able to successfully complete a basic computer course through in-hospital training.
Must successfully complete in-hospital orientation and competencies.
Demonstrates skill, organization, and efficiency in performing required activities.
Must have knowledge of Medicare Regulations and familiarity with Professional Review Organization regulations.
Must have excellent oral and written communication skills with providers, payers, and consultants with the ability to negotiate and establish effective working relationships with members of the healthcare team.
Knowledge of prospective payment systems, QIO activities, federal and state rules and regulations.
Requires exceptional organizational skills with attention to details in order to meet deadlines independently.
A spirit of inquiry is encouraged and supported.
Requisition ID: 2020-84885
Street: 1825 Logan Ave
Name: 2520 UnityPoint Health Allen Hospital
Name: Case Management
FTE (Numeric Only; Ex. 0.01): 0.4846
FLSA Status: Non-Exempt
Scheduled Hours/Shift: Weekend Package/8a-8:30p/Sat & Sun/ 4 of 5 weekends
External Company URL: http://www.unitypoint.org