Registered Nurse (RN) Care Manager PRN - Inpatient Rehab Unit

Core Responsibilities and Essential Functions

Disposition Planning

• Implements Discharge planning and provides resource information in a timely and efficient manner.
• Identifies and documents barriers for timely disposition.
• Collaborates with other members of the health care team in planning care appropriate for age.
• Provides education/counseling to patient/family in understanding, accepting and following medical recommendations of his/her conditions.
• Provides assistance with Advance Directives for customers throughout WellStar Health System.
• Understands eligibility processes and criteria for both private and public local, state and federal resources.
• Responds to referrals from hospital staff, physician offices, community and family to provide resource information, counseling and education to the community.
• Provides financial needs assessment for patients in need of assistance for follow-up care throughout the continuum.
• Provides follow-up for patients needing post-discharge assistance.
• Allows for any cultural or religious beliefs in providing service and continuity of care.
• Always partners with the patient and significant others (as appropriate) using such appropriate method for setting and purpose (e.g., interdisciplinary rounds, keeping the patient and significant others updated and making the patients goals the focus of the plan of care.)

Exemplary Practice and Outcomes

• Participates in the development of protocols and procedures when called upon or through self-initiation in collaboration with care managers and other members of the health care team to achieve best practice outcomes (i.e. decrease in re-admission rates, avoidable days, adverse events, etc.)

Resources and Support Utilization Management

• Initiates assessment for necessity and appropriateness of health services by the application of established screening criteria (e.g. Interqual).
• Timely identification and referral for alternative level of care.
• Responsible for timely and accurate certification of hospital admission.
• Provides required information to payors.
• Monitors and evaluates patient/clients ongoing plan of care and facilitates modification utilizing established screening criteria to determine level of care with documentation in the computerized Utilization Management module.
• Monitors and evaluates the appropriateness of managed care denials and collaborates with attending physician and managed care representative and Medical Director or VP Medical Affairs.
• Monitors for compliance of Medicare/Medicaid regulations (e.g. order for patient type for billing, appropriate billing).
• Negotiates and refers for services outside of patients health care plan.
• Evaluates and negotiates patients needs based on quality, cost and necessity.
• Participates and supports performance improvement inclusive of all stakeholders, research and research utilization to promote safe, quality patient care including initiating and/or leading such activities as well as, promoting an inter/intra-disciplinary process and actively supports/participates in shared governance at all levels in the system.

Teamwork and Collaboration and Evidence Based Practice Research Assessment

• Initiates assessment for necessity and appropriateness of health services by the application of established screening criteria (e.g. Interqual).
• Assesses insurance and coverage issues such as managed care, PPO, HMO, and the identification of preferred providers.
• Identifies issues relating to patient type and/or appropriateness of admission and collaborates with physician/physician advisor for resolution.

Documentation

• Initial psychosocial /functional assessment completed and documented in medical record.
• Complete chart notes accurately and timely per Departmental protocol.
• Ensure all records are up-to-date and legible.
• Complete all Electronic Medical Record software screens.
• Ensure timely and accurate documentation of clinical reviews and insurance updates as required by payor.
• Accounts for and indicates all services delivered in Electronic Medical Record.
• Participates in data collection, poses relevant clinical questions to advanced evidence-based practice. Consults appropriate experts and uses appropriate resources and evidence to address practice questions.

Evidence Based Practice and Research Professional Development and Initiative

• Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
• Serves as a preceptor and/or or mentor for other professional and/or students, to ensure that there is a current and future qualified workforce.

Performs other duties as assigned. Complies with all Wellstar Health System policies, standards of work, and code of conduct.