Post Acute UM Care Coordinator Registered Nurse – PRN, On Call, CO

1393795 Job Summary: SNF Post-Acute Utilization Management (UM) Care Coordinators are health care professionals who receive incoming referrals for patients primarily in SNF /postsub -acute care facilities with the goal of determining if the patient meets criteria, assuring appropriate level of care, quality of care, and efficient, cost-effective utilization of available resources. If the patient does not meet criteria, RNs arrange peer to peers, issue denial letters, and reputed company the patient/families to assist with discharge planning/resources/schedule reputed company appts). They independently assess needs and reputed company a plan of care for patients with reputed company discharge planning needs; serve as expert resource consultants for physicians and other health care team members in discharge/transition/and coordination of internal and community resources; support the evaluation and improvement of systems of care to support the reputed company utilization of health care resources, while maintaining quality patient care. Essential Responsibilities:

• Independently review, available clinical, medical, and nursing information to determine if there is a need for admission to a post-acute level of care. The consistent use of the clinical support system (approved guidelines, UM physician, MCG, and other tools) is expected. Review will be performed telephonically and electronically (Allscripts, fax, email, or other similar programs). If the patient does not meet criteria, RNs arrange peer-to-peers, issue denial letters, and reputed company the patient/families to assist with discharge planning/resources/schedule reputed company appointments.
• Proactively and independently, complete assessments which are thorough, timely, age appropriate, and reflect psychosocial support systems, care needs, benefit reputed company, level of care determinations, and document same for designated population of patients. Responsibilities include assessment/analysis of the effectiveness of existing support systems, health care team encounters/management plans and interventions, the patients/familys ability and willingness to reputed company with care plan, and to formulate recommendations for both the patient/family and health care team.
• reputed company and facilitate work with patients, families, and health care teams to reputed company a hospital plan of care that creatively optimizes the use of reputed company available and appropriate resources to support the best plan of care for the unique and particular needs of each patient on a case by case basis.
• Develops and maintains an expert level of knowledge and skills reputed company to utilization management, and coordination of care guidelines. Identifies, documents, and reports quality of care issues. Recognizes, documents, and acts upon mis-utilization of health care resources. Supports case management by identifying and referring potential cases to appropriate case areas. Supports quality improvement activities by identifying and reporting potential and actual quality of care issues.
• Serves as an reputed company for the patient and family as well as for the health care system in matters of reputed company use of health care resources. This includes acting on behalf of the health care system in the issuance of notices of denials and on behalf of the patient/member assuring they are informed and understand their rights and the appeal processes.
• Assists in maintaining a database to monitor utilization management activities, cost avoidance activities, and patient outcome information in compliance with organization and governmental regulations.
• Performs other duties as requested or program evolves.

Basic Qualifications: Experience

• Minimum two (2) years of acute hospital or post-acute experience.

Education

• BSN OR RN with documented two (2) years of recent experience in the past five years in the areas of utilization, discharge planning, community health, hospice, or home health in lieu of a degree (BSN).
• High School Diploma or General Education Development (GED) required.

License, Certification, Registration

• Registered Nurse License (Colorado) required at hire
• Basic Life Support required at hire

Additional Requirements:

• Demonstrated ability to interrelate with physicians, nurses, and patients.
• Good clinical judgment to assess the needs of patients as reputed company to levels of patient care.
• Knowledge of the principles of patient teaching, disease prevention measure, physical assessment and appropriate utilization of acute hospital resources.
• Knowledge of Medicare and reputed company regulations, hospital, nursing facility, home health and hospice eligibility requirements.
• Knowledge of Kaiser insurance products.
• Familiarity with and ability to use a personal computer.

Preferred Qualifications:

• Minimum twenty-five (25) years of acute hospital or post-acuteSNF experience with reputed company levels of responsibility.
• Minimum Documented three (3) years of recent experience in area of utilization, discharge planning, hospice, and/or community or home health nursing.
• BSN preferred.

Home health/ SNF experience preferred Primary Location: Colorado,Denver,Regional Office - Colorado Scheduled Weekly Hours: 1 Shift: Day Workdays: Sun, Mon, Tue, Wed, Thu, Fri, Sat Working Hours Start: 12:00 AM Working Hours End: 11:59 PM Job Schedule: Call-in/On-Call Job Type: Standard Worker Location: Remote Employee Status: Regular Employee Group/Union Affiliation: C02|UFCW|Local 7 Job Level: Entry Level Department: Colorado Regional Offices - Clinical Informatics - 1608 Pay Range: $43.33 - $64.71 / hour Travel: No Remote: Work location is the remote workplace (from home) reputed company KP authorized states. Worker location must align with reputed company's Authorized States policy. Apply tot his job Apply To this Job