UnityPoint Health Utilization Management/Care Coordinator in Fort Dodge, Iowa
UnityPoint Health - Fort Dodge
Utilization Management/Care Coordinator
FTE: .9 (full-time, 36 hours per week)
UM Coordinator Responsibilite
Maintains a working knowledge of requirements of payers across the continuum.
Possesses an ongoing commitment to monitor resource consumption throughout the patient stay.
Collaborates and communicates with all members of the health care team regarding patient LOS, payer constraints and authorizations.
Demonstrates commitment to performance improvement efforts on an ongoing basis.
Maintains knowledge and is accountable for accurate patient level of care.
Completes continued stay reviews for medical necessity.
Reviews, evaluates and participates in completing any referred denials or appeals.
Educates the health care team about utilization management concepts
Maintains knowledge of criteria used in admission and discharge process.
Participates in organizational and unit activities that contribute to patient safety, quality outcomes, and patient satisfaction.
Care Coordinator Responsibilities
Interdisciplinary Team Leader
· Coordinates the plan for the stay and the plan of care with patients, family and interdisciplinary team.
· Ensures effective communication through the continuum to support ongoing progress toward identified outcomes
· Leads and participates with the interdisciplinary team in daily rounds, planning delivery and evaluation of patient-focused care.
· Ensures effective communication and flow of information to all appropriate care providers.
· Identifies patients with potential palliative care needs and makes appropriate referral
Patient care & advocacy
· Patient rounding - rounds on each patient daily.
· Physician rounding – prioritizes and rounds with physicians daily to promote communication and effective discharge planning.
· Assists in obtaining baseline information utilized for the development of individualized patient plan of care.
· Provides direct and indirect patient and family care as needed to develop plan of care.
· Assesses patient’s response to treatment and care through other care provider information or by examining patient directly
· Provides or oversees the education of the patient and family to understand illness and self care concepts
· Supports patient’s right to make decisions about care and treatment.
· Develops a partnership with care providers and patient and patient’s family.
· Ensures that patient goals are set with patient.
Plan of Care
· Monitors patient’s progress against plan of care until discharge from designated patient care area.
· Ensures the plan of care is accessible to the patient and family to assist them in understanding goals of care and movement toward these goals.
· Performs or oversees the development and implementation of a plan of care.
· Ensures the effective education of the patient and patient’s family to prepare for discharge, helps to facilitate patient discharges
· Implements strategies to reduce resource consumption and length of stay for assigned patients e.g. appropriate use of telemetry, diagnostic testing for outpatient arena, such as treatments and infusions.
· Identifies resources needed for optimal patient care, substantiates the need for resources.
· Communicates changes in plan of care to the patient/family and the health care team members in a timely manner.
· Involved and educates interdisciplinary team, patient/family on plan of care.
· Collects data on patient outcomes on the unit e.g. patient satisfaction, pressure ulcers, medication errors, falls, core measures, critical test results, etc.
· Develops and utilizes tools to effectively evaluate, summarize and communicate patient’s progress toward outcomes to members of the healthcare team and patient and family.
· Seeks opportunities to make improvements to reduce risk.
· Is involved in safety initiatives at the department and interdepartmental levels to improve care outcomes.
· Perform interview to begin A3 on readmissions and coordinate with performance improvement.
· Assure patient has Advance Directive (AD) and is clearly documented and communicated via the Durable Power of Attorney (DPOA), living will, IPOST as advanced directive. If ADs are absent facilitates completion of appropriate forms.
· Works with team members, other leaders and physicians to develop and trend performance improvement indicators based on national standards and best practices.
· Leads and educates staff to ensure best practices are followed in relationship to adherence to care measures.
· Responsible for the safe discharge planning/transition to next level of care and communication of plan to patient/family, physician, team members and next level of care.
· Makes direct referrals to home care, next level of care, e.g. nursing facility in collaboration with social worker, palliative and hospice care as appropriate.
· Provides input to nursing leadership on the evaluation and competency of nursing staff.
· Provides formal and informal educational opportunities on the unit Acts as role model and demonstrates expertise in conflict resolution and negotiation.
· Acts as a role model and demonstrates Standards of Behavior
· Reviews compliance with regulatory agencies related to patient safety including Det Norske Veritas (DNV), Occupational Safety and Health Administration (OSHA), Centers for Medicare and Medicaid Services (CMS) and others.
· Delegates aspects of care to qualified personnel.
· Acts as consultant to clinical staff in assisting or finding resources when unfamiliar procedures/treatments present.
· On a daily basis delegates, supervises and evaluates the nursing care given by others while retaining accountability for the quality of care given to the patients.
· Serves as a professional role model/mentor and change agent to develop and assist others.
· Participates in real time problem solving utilizing the A3 tool; collects the current state and engages nursing staff in the process
· Provides precise communication to other team members.
· Maintains clinical competence in the care of a designated patient population.
· Disseminates & implements latest evidence based practices.
· Certified Medical-Surgical Registered Nurse (CMSRN), Progressive Certified Nursing (PCCN) or Care Coordination and Transition Management Certification (CCCTM) preferred.
Basic UPH Performance Criteria
· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
· Demonstrates ability to meet business needs of department with regular, reliable attendance.
· Employee maintains current licenses and/or certifications required for the position.
· Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
· Completes all annual education and competency requirements within the calendar year.
· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
Associate Degree of Nursing. Bachelors’ of Science in Nursing preferred.
Minimum of five-(5) year’s broad-based clinical experience required. Preferable clinical experience will be in specialized case management area.
Current RN Licensure in State of Iowa or applicable compact state. Must be licensed in state of residence. Valid driver’s license when driving any vehicle for work-related reasons.
Must demonstrate effective communication skills. Ability to delegate wisely, exercise good judgment, maintain effective interpersonal relationships, adapt to change, evaluate critically and think creatively. Must demonstrate knowledge and skills required for specialized area of assignment. Basic Life Support certification.
Electronic mechanical record, computer, fax machine, electronic and mechanical patient care equipment, office equipment and access Web for patient resources.
PROTECTIVE EQUIPMENT: gloves, gowns, masks
Requisition ID: 2021-86770
Street: 802 Kenyon Rd
Name: 7020 UnityPoint Health Trinity Regional Medical Ctr
Name: Case Management
FLSA Status: Non-Exempt
Scheduled Hours/Shift: 36 hours per week; Monday-Friday
External Company URL: http://www.unitypoint.org