Department: 200766 Care Coordination
Facility: Renown Regional Medical Center
Reno, NV
Schedule: Full Time - Eligible for Benefits
Shift: Day
Hours: Varies
Job Details:
  • Position Purpose:

     A collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates options, services and alternative levels of care to meet an individual's needs.  By assuming a leadership role with the interdisciplinary team, the Care Coordinator RN promotes appropriate utilization, high quality care and cost effective outcomes.  The Care Coordinator RN, is responsible for Utilization Review, performs admission and concurrent reviews using Severity of Illness / Intensity of Service (SI/(S) criteria by reviewing the client's medical record and communicating with the physicians and payors regarding the medical necessity for services.

    Nature and Scope:

    The Care Coordinator RN has the responsibility to promote case management activities through

    the health continuum, beginning in the acute setting.  Case management begins with the

    assessment of pre-morbid health status, current medical condition and post-acute needs.  The Care Coordinator RN performs admission and concurrent continued stay reviews to ensure that services are being delivered at the most appropriate level of care to meet the client's needs and to secure reimbursement from payers.

     

    Utilizing an interdisciplinary team approach, the Care Coordinator RN acts as a consultant and educator on matters referring to alternative levels of care, managed care issues, and community resources. In collaboration, to provide optimal patient care through, assessment, planning, implementation, and evaluation of neonatal, pediatric, adolescent, adult, and geriatric patients and families. This position also provides information such as certified LOS and reimbursement issues to physicians as needed to ensure the appropriate and timely disposition of the client to the next level of care.  The Care Coordinator RN monitors and documents the progress of the plan, making revisions as needed, to assures a smooth transition to the next level of care at the time of discharge.

     

    The Care Coordinator RN must respect beliefs and values while advocating for the client's right to self-determination and to make informed choices.

     

    The Care Coordinator RN documents all chart and phone reviews, identifies and communicates potentially avoidable/non-reimbursed days, quality indicators (such as re-admissions) and core measures. As indicated, delivers non-coverage letters as set forth by payer and/or regulatory compliance.

     

    The Care Coordinator RN acquires and maintains knowledge and competencies related to the expectations of their position including an extensive knowledge of post-acute admission criteria (Rehab, LTAC and SNF etc.).  Practice is aligned with the mission, vision and goals of the Integrated Health System. She/he participates in Quality Improvement initiatives.

     

     This position does not provide patient care.

    The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

    Minimum Qualifications:  Requirements - Required and/or Preferred

    Education:

    Must have working-level knowledge of the English language, including reading, writing and speaking English. Appropriate education to obtain and maintain State of Nevada Registered Nurse licensure. Bachelor of Science in Nursing preferred.

    Experience:

    Minimum two years acute hospital experience, within the last 5 years required. Case Management, Post-Acute experience and/or UR/QA experience preferred.

    License(s):

    Ability to obtain and maintain a State of Nevada Registered Nurse license.

    Certification(s):

    National Certification  (i.e. Case Management (CCM), Professional Utilization Reviewer (CPUR), or Managed Care (NMCC)) preferred. Current BLS/CPR certification required.

    Computer / Typing:

    Must be proficient with Microsoft Office Suite, including Outlook, PowerPoint, Excel and Word and have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

     



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