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Job CategoryPatient Services
Job FamilyCare Coordination
DepartmentRCH Care Management
Scheduled Weekly Hours40
Job SummaryResponsible for collaboration with medical staff, patients, family, and the Healthcare team by assessing, facilitating, planning, and advocating for health needs on an individual basis resulting in quality, cost-effective outcomes. Establishes goals and priorities consistent with mission and goals of Monument Health, as well as meets requirements of JCAHO and other applicable federal, state, and local regulatory and/or accrediting bodies.
- Coordination of services for hospitalized patients whose care needs range from observation level of care to emergent/urgent higher level of care transitions to include facilitation of payer authorization and transportation.
- Patient triage for hospitalized patients to ensure transitions to other appropriate settings which range from post-acute care to acute care transitions.
- Uses critical thinking skills to assist providers in establishing plan of care recommendations for hospitalized patients.
- Partners with providers and Physician Advisors/Medical Directors to escalate cases for review on complex cases in compliance with Conditions or Participation and Escalation standards.
- Optimize care coordination with hospital, ER, nursing homes, assisted living facilities, physicians and community resources as necessary. Facilitates planning for patient/family needs to ensure a smooth transition for the patient across the continuum of care.
- Coordinates the provider aspect of federal/state organization functions as detailed in the Conditions of Participation and other appropriate regulations.
- Supports the Medical Staff Quality Review process by identification of issues related to quality indicators set forth by the Medical Staff.
- Creates and updates the Plan of Care (POC) to include patient/family-centered goals with interventions that reflect the changing needs of the patient/family unit and is consistent with their current needs and desires.
- Maintains a working knowledge and relationship with community resources and payer benefits that link the individual with the most appropriate resources. Assists by maintaining expertise on benefits, reimbursement and contract/regulation changes per payer guidelines, Medicare and Medicaid to facilitate appropriate reimbursement, education and guidance to assist the Healthcare team and patient/family in decision making.
- Facilitates planning for patient/family needs to ensure a smooth transition for the patient across the continuum of care to include offering guidance to patients / families regarding applications for funding, guardianship and charity care programs as needed.
- Evaluates current treatment plan to identify barriers, determine realistic goals and objectives, and seek potential alternatives in conjunction with the medical staff. Coordinates team efforts with support services departments to ensure appropriate care and smooth discharge transition.
- Is a visible resource on the unit and coordinates interdisciplinary team huddles/communication, identifying and communicating the patient’s Healthcare needs based on the best practice standards to ensure care and communication needs are met in relation to both internal and external providers/services, ancillary department services, core measures, compliance with internal policies/regulatory guidelines and True North metrics.
- All other duties as assigned.
Education - Associates degree in Nursing
Certification - Registered Nurse (RN) - South Dakota Board of Nursing
Education - Bachelors in Nursing
Experience - 5+ years of Acute Experience; 5+ years of Registered Nurse Experience
Certification - Commission for Case Management Certification (CCMC) - Accredited University or accredited training professionals
Medium work - Exerting up to 50 pounds of force occasionally, and/or up to 30 pounds of force frequently, and/or up to 10 pounds of force constantly to move objects.10 Monument Health Rapid City Hospital, Inc.
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