Registered Nurse (RN) PRN - Care Coordination

Wellstar Health System; Griffin (GA); On-site; USD 41,000 - 69,000; Full time

Job summary

Wellstar Spalding is seeking a PRN RN Care Coordinator to join their team in Georgia. The role focuses on coordinating care across the continuum for acute and chronic illness, including discharge planning and utilization management.

The RN will collaborate with the care team, educate patients and families, and support adherence to policies while aiming to improve outcomes and patient satisfaction.

Qualifications

• Associate degree in Nursing or Diploma in Nursing (RN) required.
• Current RN license in Georgia.
• Minimum 3 years of clinical practice; 3–5 years preferred.
• Knowledge of Case Management and utilization management.
• Excellent organizational and communication skills.
• Experience with EMR systems and discharge planning preferred.

Responsibilities

• Coordinate care across acute, chronic, and long-term stages for a defined patient population.
• Perform discharge planning and identify barriers to timely disposition.
• Provide education to patients and families and support advance directives.
• Facilitate utilization management and documentation in EMR.
• Collaborate with care team to meet quality outcomes and reduce readmissions.
• Assess insurance coverage and assist patients with access to resources.

Skills

Case Management

Organizational Skills

Communication Skills

Screening Criteria

Care Coordination

Education

Associates Nursing or Diploma

Tools

EMR software

Job description

Work Shift

Various (United States of America)

Wellstar Spalding is seeking a PRN RN Care Coordinator to join their amazing team!

Ideal Candidates Will Possess The Following

• Prior Medical Care Coordination experience in an Acute Care setting.

Job Summary

The Care Coordinator is responsible for coordination of care across the continuum during the patient's acute, chronic and long-term stages of illness for a defined patient population. This includes utilization management, transitional care planning, psychosocial and functional status assessment, patient advocacy, education for the patient/family, and monitoring quality indicators to demonstrate outcomes resulting from the service provided. Collaborates with all team members to provide a comprehensive assessment of the patient's plan of care, goal/outcome attainment and continued care needs.

It is expected that all RN Clinical Nurses are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association. As a member of the patient services team, it is expected that the individual upholds the voice of the patient, System policies and procedures while supporting service excellence goals and providing and unwavering focus on exceeding the expectations of our patients and consumers.

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.)

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.

Required Minimum Education

• Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Required Minimum License(s) And Certification(s)

All certifications are required upon hire unless otherwise stated.

• BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I - Basic Life Support - Instructor
• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact or LCSW - Lic Clinical Social Worker GA or LMSW - Lic Master Social Worker GA or MSW - Master Social Worker

Required Minimum Experience

Minimum 3 years Three to Five years Clinical Practice/Experience Preferred

Required Minimum Skills

Knowledge of Case Management process.

Excellent organizational and professional communication skills.

Knowledgeable in utilizing screening criteria in review of clinical data with respect to patients/clients needs for health care.

Ability to effect change performs critical analysis, promote client/family autonomy and plan and organize effectively for the continuum of care.

Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.