Rn Clinical Coordinator - Pruitthealth Premier

Job Purpose

Responsible for the oversight of clinical care management and care oversight of an identified caseload of PruittHealth Premier Plan members that reside in long term care facilities and areenrolled in the PruittHealth Premier I-SNP.Works In collaboration and consultation with the Plan Provider, staff RN's and other health care professionals and provides care coordination and care management activities on behalf of the PruittHealth Premier Plan. Collaborates with the Plan Nurse Practitioner/PA to assist in managing the member’s care needs, preventing acute and chronic illness and disease, and promoting wellness. Assist patients to achieve optimal health status utilizing the most cost-effective quality resources through application of model of care practice guidelines.Implement appropriate interventions to manage multiple physical, psychological, social and financial barriers in cooperation with the patient, PruittHealth Premier, and medical provider.

Key Responsibilities

Duties may include, but not limited to the following:

• Facilitates agreement and implementation of the member's plan of care by engaging beneficiary, the facility staff, families/responsible parties, primary and specialty care physicians
• Ensures all Members have an ICP developed within 2 business days of HRAT by Plan Provider
• Follow up on medium acuity patients as directed by the Plan Provider.
• Coordinate care as member's transition through different levels of care and care settings, ensures that the ICP is communicated immediately and/or no later than 1 business day to the receiving care setting
• Function as an effective liaison between patient, PruittHealth Premier Plan Provider, facility staff, and other community health providers to ensure appropriate clinical oversight and engagement is provided
• Collaborate with Plan Provider (NP/PA), case managers, social workers, family members, key care givers and any appropriate ancillary medical personnel as appropriate
• Responsible for coordination with facility staff for scheduling and completion of the inter-disciplinary team meeting quarterly with the Plan Provider and Interdisciplinary Care Team.
• Check in daily with each assigned facility (each nursing station) to determine members needing more urgent visits.
• Complete comprehensive, adult/geriatric assessment as required for patient change in condition assessment to report findings to the Plan Provider timely to allow them to provide changes to the plan of care/implement new orders.
• Reviews laboratory data to escalate concerns timely to Plan Provider and recommend appropriate follow-up
• Reviews and interprets the medical and social history of members
• Ensure members have access to supplemental benefits and ancillary service providers as clinically needed or annually for wellness related benefits.
• Monitor the needs of patients and families on an ongoing basis while facilitating any adjustments to the plan of care as changes are needed.
• Coordinate with utilization management and hospital case management as needed for member transitions to and from and acute setting.
• Understand the PruittHealth Premier Plan benefits, PruittHealth Premier Plan policies, procedures and articulate them effectively to providers, members and key decision-makers
• Responsible for identifying overall quality improvement activities
• Assists with Health Risk Assessment within seven (7) days of enrollment for a new beneficiary and annually within one year of the initial assessment.Completes the record review and validates and updates the HRA for Plan Provider to review when doing their comprehensive exam.
• Performs other duties as assigned
• Conduct care coordination for any member discharged from a PruittHealth facility with facility staff, patients and caregivers to ensure access to appropriate care resources based on their setting of care in a timely manner.
• Ability to effectively reconcile medications
• Ensures that individual plan of care is developed with specific interventions designed to meet the needs identified in the Health Risk Assessment
• Assist with IV insertions, lab draws, and wound care as ordered by the Plan Provider
• Identify and document the needs of clinically complex patients including high acuity and skilled patients.
• Attend monthly QAPI meeting if Plan Provider is unable to attend.
• Helps to assure that the patient has access to primary care provider (PCP) and specialists, supplemental benefit services and is understanding of treatment plan and medications and assists with coordination of transition between care settings.
• Attend morning facility meetings on days they are scheduled to be in that facility.
• Provide care management and coordination to assure that the patient progresses through the continuum of care and utilizes the most clinically appropriate and cost- effective quality resources through the application of national practice guidelines.

Knowledge, Skills, Abilities

• Comply with PruittHealth Premier’s confidentiality policy, HIPAA requirements and state and federal regulations.
• Compliance to internal and external goals/metrics established for assigned department
• Experience with electronic clinical charting/records
• Travels between care sites required
• Proven ability to pursue feedback, continuing education and professional development
• Ensure compliance with quality patient care and regulatory compliance within the company’s standards and RN scope of practice.
• Performs comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
• Demonstrates ability to recognize conditions, characteristics, and behaviors that place seniors at risk
• Adhere to PruittHealth Premier goals, objectives, standards of performance, and policies and procedures.
• Position is often required to independently plan and prioritize patient care objectives.
• Excellent time management, flexibility, and efficient organizational skills with ability to work independently and as a team player in both office/remote environment
• Demonstrates ability to identify and document chronic disease in adults
• Manage assigned case load as business needs dictate.
• Proven ability to perform comprehensive, adult/geriatric assessment
• Ability to work in triage and/or disease management role if needed
• Adherence to legal and ethical principles of privacy, confidentiality, safety, advocacy, and accreditation and regulatory standards in all case management activities in both office/remote environment
• Ability to interact with a wide variety of people and handle complex situations simultaneously with customer service focus
• Rotating on call responsibilities possible
• Attention to detail and follow-up and the ability to analyze and problem-solve

Technical Skills

• Ability to chart and follow designated workflow(s) in an electronic environment.
• Proficient in typing
• Proficient computer skills in Windows, Care Management Platforms, and general Internet use.

Communication Skills

• Strong verbal and written communication skills required to meet superior customer service and satisfaction levels.
• Ability to communicate, read, and write fluently in English
• Excellent interpersonal skills and ability to function as a member of a multi-disciplinary team.

Minimum Education Required

• Bachelors (or higher) degree preferred.
• Advanced Nursing Diploma and/or college degree in nursing required.

Minimum Experience Required

• Minimum three years industry experience in a managed care setting focused on experience in utilization review/case management and at least two years case management, home care or hospice experience strongly preferred.
• Minimum two years (full- time equivalent) direct clinical care experience required.
• Two years’ experience with long-term care population preferred

Minimum Licensure/Certification Required By Law

• Licensed Registered Nurse with current, unrestricted license in state of practice required.
• Current CPR certification
• Certified Case Manager preferred

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As an Equal Employment Opportunity employer, all qualified applicants will receive consideration without regard to race, color, religion, sex, national origin, disability, or veteran status.

Job

Nursing

Primary Location

Georgia-Rome

Other Locations

Georgia-Fort Oglethorpe

Schedule

Full-time

Shift

1st Shift

Job Posting

Jun 19, 2023, 10:06:20 PM

Work Locations

PruittHealth - Fort Oglethorpe