Works collaboratively w/ an MD to coordinate & screen for the appropriateness of admissions & Continued stays. Makes recommendations to the physicians for alternate levels of care when the patient does not meet the medical necessity for Inpatient hospitalization. Interacts w/ the family, patient & other disciplines to coordinate a safe & acceptable discharge plan. Functions as an indirect caregiver, patient advocate & manages patients in the most cost effective way w/out compromising quality. Transfers stable non-members to planned Health care facilities. Responsible for complying w/ AB 1203, Post Stabilization notification. Complies w/ other duties as described. Must be able to work collaboratively w/ the multidisciplinary team ,multitask & in a fast pace environment.
Essential Functions:
- Plans, develops, assesses & evaluates care provided to members
- Collaborates w/ physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of approp, individualized plans of care to ensure continuity, quality & approp resource use
- Recommends alternative levels of care & ensures compliance w/ fed, state & local requirements
- Assesses high risk patients in need of post-hospital care planning
- Develops & coordinates the implementation of a discharge plan to meet patient's identified needs; communicates the plan to physicians, patient, family/caregivers, staff & approp community agencies
- Reviews, monitors, evaluates & coordinates the patient's hospital stay to assure that all approp & essential svcs are delivered timely & efficiently
- Participates in the Bed Huddles & carries out recommendations congruent w/ the patient's needs
- Coordinates the interdisciplinary approach to providing continuity of care, including Utilization mgmt, Transfer coord, Discharge planning, & obtaining all authorizations/approvals as needed for outside svcs for patients/ families
- Conducts daily clinical reviews for utilization/quality mgmt activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient & non-KFH facilities
- Acts as a liaison between in-patient facility & referral facilities/agencies & provides case mgmt to patients referred
- Refers patients to community resources to meet post-hospital needs
- Coordinates transfer of patients to approp facilities; maintains & provides required documentation
- Adheres to internal & external regulatory & accreditation requirements & compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA & DOL
- Educates members of the healthcare team concerning their roles & responsibilities in the discharge planning process & approp use of resources
- Provides patients w/ education to assist w/ their discharge & help them cope w/ psychological problems related to acute & chronic illness
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities
- Reviews, analyses & identifies utilization patterns & trends, problems or inapprop utilization of resources & participates in the collection & analysis of data for special studies, projects, planning, or for routine utilization monitoring activities
- Coordinates, participates & or facilitates care planning rounds & patient family conferences
- Participates in committees, teams or other work projects/duties as assigned
Qualifications:
' This position is a SCNSC bargaining unit represented position '
Basic Qualifications:
- Minimum two (2) years of clinical experience as an RN in an acute care setting required
- Bachelor's degree in nursing or healthcare related field preferred OR current equivalent related work experience
- Graduate of an accredited school of nursing required
- Current and valid California RN license required
- Demonstrated ability to utilize/apply the general and specialized principles, practices, techniques and methods of Utilization review/management, discharge planning and case management
- Working knowledge of regulatory requirements and accreditation standards (TJC, Medicare, Medi-Cal, etc.)
- Demonstrated ability to utilize written and verbal communication, interpersonal, critical thinking and problem-solving skills
Notes:
- Schedule variable
External hires must pass a background check/drug screen.
We are proud to be an equal opportunity/affirmative action employer.