Acute Care Nurse – Hct – RN

Acute Care Nurse – Hct – RN

Requirements

• Strong interpersonal, communication and critical thinking skills are required.
• Ability to work autonomously is required.
• Fluent in English.
• Ability to monitor, assess and record patients’ progress and adjust and plan accordingly.
• Understanding utilization review and how to leverage with inpatient staff for possible reduction of medical cost on long length of stay patients.
• Ability to plan, implement and evaluate individual patient care plans.
• Knowledge of nursing and case management theory and practice.
• Knowledge of patient care charts and patient histories.
• Knowledge of clinical and social services documentation procedures and standards.
• Knowledge of community health services and social services support agencies and networks.
• Organizing and coordinating skills.
• Ability to communicate technical information to non-technical personnel.
• Proficient in Microsoft Office Suite products including Excel, Word, PowerPoint, and Outlook, plus a variety of other word-processing, spreadsheet, database, e-mail and presentation software.
• Ability and willingness to travel locally, regionally, and nationwide up to 10% of the time.
• Spoken and written fluency in English, bilingual preferred.
• Associate degree in Nursing required.

Responsibilities

• Manage and plan for transitions of care, discharge and post discharge follow up for patients admitted to key high volume/high priority hospitals.
• Collaborate with clinical staff in the development and execution of the plan of care and achievement of goals. Report variations to PCP/ transitional care physicians (TCP) and implement actions as appropriate.
• Build relationships with preferred acute care providers (hospitalists, specialists).
• Direct referrals to preferred providers.
• Coordinate the integration of social services/case management functions in the pre-acute, ER, acute and post-acute setting. Coordinate the patient care, discharge, and home planning processes with hospital case management departments, and other healthcare facilities.
• In conjunction with the PCP, hospitalist, TCP, insurance case manager and the hospital case manager, coordinate the patient transition to the appropriate/least constrictive level of care using a preferred provider.
• Keep the PCP aware of patient condition via e-mail, DASH, HITS or other appropriate means of communication.
• Introduce self to patient/family and explain nurse case manager role and process to contact nurse case manager for questions, guidance and education.
• Provide high intensity engagement with patient and family.
• Facilitate patient/family conferences to review treatment goals, optimize resource utilization, provide family education and identify post-hospital needs.
• Address advanced care planning including treatment goals and advance directives.
• Refers cases to social worker (hospital and JenCare) for complex psychosocial and economic needs.
• Obtain onsite and EMR access at priority facilities.
• Maintain clinical and progress notes for each patient receiving care and provide progress report to PCP and others as appropriate.
• Submit required documentation in a timely manner and in appropriate computer system.
• Participate in surveys, studies and special projects as assigned.

Preferred Qualifications

• Certification in case management is preferred. Hospital, healthcare setting experience is preferred.
• Minimum of two (2) years of utilization review, case management, home health and/or discharge planning experience is preferred.
• Bachelor’s Degree in nursing (BSN) or RN with bachelor’s degree in a related clinical field preferred.
• Certified Case Manager certification is preferred. Certification through the Commission for Case Manager Certification (CCMC) or the American Association of Managed Care Nurses (CMCN) desired.