RN Care Coordinator, Case Management, 8-Hours, Mornings, Weekends, 4 hour shifts on Saturdays and Sundays - Part-time

h2Overview/h2 strongYou Matter Here!/strong Heywood Healthcare values our employees! We offer competitive wages, great benefits and generous earned time off. Come work where you will matter!  p /p pstrongHours: 8-Hours, Mornings, Weekends, 4 hour shifts on Saturdays and Sundays/strong/p p /p pstrong$38.00 - $57.48 /strong/p h2Responsibilities/h2 pstrongEssential Functions:/strong/p ul liUtilization Management- Utilization Review and Care Transitions Coordination Providing clinical information to payers, monitoring length of stay, seeking necessary care authorizations and utilizing the InterQual Program; appealing denials as indicated within a timely fashion./li liReviews all new admissions and Observation patients within 24 hours of admission against High Risk Screening Criteria and documents outcome within the UM EMR./li liCompletes assessments on re-admissions within 30 days including reasoning for re-admission documents findings and provides data to the department for stratifying data./li liFollows-up on lack of documentation for medical necessity, supporting documentation with discipline identified. Trackand trend opportunities for improvement resulting in late Insurance Reviews, longer lengths of stay; including educating providers to Interqual Criteria used for determining Admission or Observation status./li liCompletes utilization reviews daily and/or as required by insurer, (concurrent and retro) for medical and/or psychiatric appropriateness according to Hospital's approved criteria timely and efficiently./li liAssesses, intervenes, evaluates and determines level of care to establish accurate admission and/or observation status; demonstrates basic knowledge of DRG reimbursement, evidenced by standardized measures for length of stay and acuity level status designation./li liDemonstrates clinical expertise specific to the issuance of ABN/HINN notice to patients and/or legal significant other and care progression. Keeping physician and team informed of status change and documenting status./li liProvides education and information to patient, family and care providers as it pertains to continuing care, care management, LOS, re-hospitalization and assure understanding of disease management/li liMultidisciplinary Team Rounds-participates in discharge planning rounds daily./li liWorks collaboratively with multidisciplinary team to determine each patient's needs concurrently including post-acute care when needed; addresses LOS issues, appropriate leveling of patient status; addressespotential needs, resources, referrals for other disciplines etc./li liQuality Statistical Data: Reviews medical record for abnormal findings,complications, delays and deviations from expected clinical outcomes reports such to Provider and/or Director to maintain an efficient, cost effective episode of care for each patient and documents intervention provided./li liAcquires knowledge to keep up with changes in technology and regulations./li liUtilizes knowledge to redesign systems for improving performance./li liContinuously prioritizes projects, activities, and tasks to ensure deadlines and customer needs are met./li liAssists with preparation of reports/statistics as it pertains to staff specific workflow./li liDenials/Appeal Process: Completes assessment of denial within 1 week providing supporting documentation with outcome of review; documents intervention in the UR EMR section./li liPrepare written appeal letters, termination letters, discharge notices, MOON and IMs when appropriate as per regulatory standards and department policies. Report any variances, trends to director. Submits denials/appeals when completed to the department secretary for processing./li liDischarge Planning:Communication: builds rapport and responds to needs of physician, reviewers for managed care plans, healthcare team members, 3rd party payers, outside reviewers and vendors to enhance internal and external customer service satisfaction./li liResponsible for completing nursing sections of the SNF Level of Care forms for Mass Health patients in need of care SNF placement, timely and efficiently and other forms assisting in transition of care as identified and collaborates with the social worker. In the event of an emergency, Care Coordinator may complete the form in full and process it to help expedite discharge planning process and length of stay./li liThe Discharge Planning Process:Completes discharge planning assessments timely, efficiently and completely following regulatory standards and departmental policies assuring appropriate patient flow. Appropriately levels patient for home discharge with or without services or to another type of facility such as a SNF, Acute Rehab etc. Develops coordinates and implements discharge plan on cases assigned with patient and/or family/so caregiver./li liIdentifying patient preference and selection choice for HHA/SNF placements having patient preference form checked off and signed/dates by patient and/or so. When plan is in place, notify provider establish and determine anticipated readiness for discharge, keeping patient/family/so informed and documenting such in the EMR. Closes case out using appropriate forms for transition of care communication timely and efficiently./li liThe Care Coordinator collaborates with the team to assist the Multidisciplinary Team in providing discharge planning activities to assist in expediting a patient’s discharge as part of the care transitions process. It is the expectation that the Care Coordinator remains current and proficient in the discharge planning process in the event coverage is needed./li liPerforms any and all other duties as assigned by director and/or designee./li /ul  strongStatement of Other Duties:/strong This document describes the major duties and responsibilities for this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that employees may be asked to perform job-related duties beyond those explicitly described.  pstrongFunctional Demands/strong/p pPhysical Requirements:/p pExerts 20 to 50 pounds of force occasionally, and/or up to 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects.  Frequently reaches (extending hands and arms in any direction), handles (seizing, holding, grasping, turning, or working with hands), and feels (perceiving attributes of items such as size, shape, temperature or texture by means of fingertips).  Occasionally stoops (bending the body downward and forward by bending the spine at the waist), and kneels (bending the legs at knee to come to rest on knee or knees)./p p /p strongOrganizational Expectations/strong Behavioral Attributes: The following behavioral attributes are required: achievement motivation, flexibility, concern for order, initiative, self-confidence, self control, customer service orientation, interpersonal effectiveness, teamwork and information seeking.  h2Qualifications/h2 pstrongJob Requirements/strong/p pMinimum Education/p ul liBSN preferred/li /ul pMinimum Work Experience/p ul liPrevious UR/QA experienced required/li li2 years of healthcare experience within the Acute Care, SNF, HHA, Behavioral Health and/or Insurance Industry preferred/li /ul pMinimum License and Certifications/p ul liCurrent Massachusetts Registered Nurse License/li /ul pRequired Skills/p ul liInterqual experience or equivalent preferred/li liMeditech Expanse experience preferred/li liProficient computer skills required/li liMust have effective written, verbal and interpersonal communication skills/li liExcellent critical thinking /li liAbility to multitask and flexibility essential /li liDischarge planning experience as it pertains to the care transitions, referral process, patient preference/choice services, patient family satisfaction, post discharge follow-up etc. /li /ul