RN Coordinator in Depew, NY
Family Choice of New York Posted: 2023-11-17
Depew, NY 14043
Salary Range: $78,000.00 - $85,000.00 per yearThe Registered Nurse (RN) Coordinator acts as the “eyes and ears” of the plan’s care management and utilization management team by communicating real time information about the member’s needs and helping to assure that the member is receiving the most effective care possible in the most appropriate setting.
The availability to understand and value these two critical plan functions is essential to the role.
Direct or indirect oversight of the UM/Transitions Clerks in the review and approval of all Levels of Service and provide determination with respect to facilities within your assigned team.
Responsible for utilization management, conducting utilization reviews for all Levels of Care within your assigned team.
May assist with after hour requests for non-emergent transportation including scheduling of trips with vendors and recording necessary data.
Review potential Levels of Service coverage requiring, further discussion with Executive Director of ISNP and Clinical Operations and UM and Transitions Lead or Medical Director as indicated.
Other duties as assigned.
Oversight of Transitional Care Management across all SNP programs.
Document details of member transition in EHR or Care Management Record.
Actively communicate with network partners regarding transitions.
May perform concurrent review of in-patient admissions.
Receiving and documenting Transitions of Care for SNP Members: Inpatient , ER, Observation, and all planned and unplanned transitions.
Send the Transitional POC documentation to the new care setting via fax.
Ensure that all stakeholders (PCP, APP, SW, RN, CC) are aware of the transition with timely notification via phone, EHR or E-mail as appropriate.
Communicate with member’s social worker to ensure that the member’s HCP and/or family member, as specified in the EHR, is aware of the transition of care.
In the event of a planned Transition of Care Setting (SNF to hospital for scheduled procedure, admission of SNP member from community to SNF for rehabilitation), all notifications are done in advance as is practicable.
Verify that all notifications specified above are documented in the member’s EHR.
Advise health plan of prolonged or clinically intensive hospitalization per policy.
May send transition POC to the receiving care setting.
Other duties as assigned.
Collaborate and act as a resource for quality and regulatory issues with the management team, clinical team, and other departments.
May assist Care Managers (SW) or RNs or Care Coordinators with ICP development and compliance.
Provide back up to department team members as needed.
Provide weekend RN on call coverage in a rotation with other RN’s.
Prepare quality review of transitions of members within assigned team in preparation for ISNP and CSNP IDT meeting or at request of management.
Reviews and signs Individualize Care Plan (ICP).
May visit assigned facilities or members on a pre-determined frequency or as indicated to monitor changes and acuity.
Document visits and/or observations, as applicable, in the electronic medical record within company guidelines.
Communicate observed or suspected changes in mental or clinical health/well-being with the Advanced Practice Provider (APP).
Actively participate as a member of the Interdisciplinary care team (ICT).
Conduct review of chart and member contact notes for informational gathering purposes.
May perform company audits/data collection, complete summaries per direct manager when requested/needed.
May identify trends and areas for improvement within partnering facilities as the result of rounding/audits.
May conduct informal facility staff education and teaching to improve the effectiveness and efficiency of care delivery.
Attend meetings as assigned by management.
Other duties as assigned.
EDUCATION: RN license, Bachelor’s degree, and/or equivalent work experience in program management, business, or related field preferred.
· Five years’ experience with and understanding of systems for the geriatric and frail populations.
· Computer literate: email, electronic record management, Word, and Excel.
· Ability to recognize and assess subtle changes (clinical, mental) in member status and be able to communicate these changes to appropriate staff.
· Requires outstanding people, communication and listening skills.
· Must be able to build and maintain collaborative, cooperative, productive relationships with all internal and external customers including members and their families, nursing facility staff, physicians, the health plan and other community stake holders.
· Must collaborate with other staff and work as part of a team.
· Outstanding written and verbal skills, ability to handle sensitive issues.
· Ability to meet and maintain necessary requirements per facility guidelines based on job assignment. These requirements may be outside the scope of Family Choice policies.
· Ability to maintain upmost confidentiality with restricted and secure company/provider communications, employee files, and members’ private health information.
· Excellent writing skills and exceptional knowledge of the English language including rules of composition and grammar; collegiate level writing required.
· Knowledge of administrative procedures and relevant systems including Microsoft Office (Word, Excel, Outlook, PowerPoint, and Visio).
Job Type: Full-time
Salary: $78,000.00 - $85,000.00 per year
Benefits: 401(k), 401(k) matching, Dental insurance, Employee assistance program, Flexible spending account, Free parking, Health insurance, License reimbursement, Life insurance, Malpractice insurance, Paid sick time, Paid time off, Bonus opportunities
Please fax resume to 716-558-0279
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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, gender identity or expression, age, or national origin.