Mid America Health is seeking a full time Clinical Nurse-Discharge Planner to work at Keesler AFB in Biloxi, MS.
SUMMARY: Provides discharge planning services to all individuals admitted to the medical treatment facility as inpatients or same day surgery outpatients. Either before or at the time of the patient�s admission, accomplishes a focused, early identification of services that will be required during the post-hospitalization treatment and recovery period. Facilitates the transition to the appropriate level of care through coordination with the patient, the patient�s family/caregiver and the multi-disciplinary healthcare team. This includes consideration for, but is not limited to, acute, chronic, multiple, complex, catastrophic, or life-threatening illnesses; combat stress, residuals of traumatic brain injury; community adjustment; addictions and other health problems. Works collaboratively with utilization management, case management and the healthcare team to achieve a timely, appropriate discharge that meets the patient�s needs and is per local facility/AF/DoD and national utilization and discharge standards. Evaluates care and outcomes to ensure the most appropriate and effective care and services.
Duties:
The duties include but are not limited to the following:
*Assessment. Proactively identifies and evaluates patients for discharge planning/case management within 24 hours of identification or notification, or by close of the first business day after a weekend or holiday. Conducts systematic, on-going, thorough collection of patient�s physical, emotional, psychological, social and medical status and information via direct patient contact, family/caregiver, and other relevant sources such as professional and non-professional caregivers. Reviews the patient�s medical record against McKesson (InterQual) discharge planning criteria to determine readiness for discharge.
*Planning. Develops an appropriate patient-specific discharge plan of care within 5 working days. Coordinates, collaborates, and obtains approval of the plan among the patient, family/caregiver, primary provider and other members of the healthcare team. Documents review of the plan in the patient�s medical record. Develops a proactive process for patients undergoing same day surgeries, anticipating actual and potential needs for post-operative services.
*Implementation. Coordinates and executes the discharge plan with the patient and family/caregiver, optimizing access to appropriate services. Ensures necessary referrals are ordered by the appropriate discipline and coordinated. Serves as an advocate for, and ensures education is provided to, the patient and family/caregiver as required. Promotes adherence to the discharge plan for improved healthcare outcomes.
*Coordination. Ensures coordination of care delivery processes, to include alternate healthcare settings and the home environment, for the purposes of enhancing the patient's health and wellness, safety, productivity, and quality of life, and for providing the most beneficial, cost-effective health care. Develops, utilizes and maintains a variety of military and community resources to optimize access to services and medical care. Ensures timely and appropriate provision of services.
*Monitoring. Re-evaluates the patient and the plan every 72 hours until discharged per McKesson (InterQual) guidelines, aligning the plan with TRICARE benefits and policies Documents in accordance with existing local facility/AF/DoD and other agency guidelines. Maintains data collection in accordance with local facility/AF/DoD and other specified agency guidelines. Such data includes but is not limited to resource utilization and patient outcomes, and Length of Stay (LOS) and Avoidable Bed Days, analyzing for variance, appropriate interventions and cost containment.
*Evaluation: Actions may include timeliness of completion of the discharge plan, patient�s adherence and response to the plan, identification of variances, patterns or trends from established practice guidelines and/or standards, established outcome measurements, results of interventions, treatment delivery and timeliness of care, and utilization of resources. Monitors and evaluates the facility�s discharge planning program per local facility/AF/DoD policies and guidelines.
*Coordinates and participates in interdisciplinary team meetings, designated facility meetings, and Discharge Planning meetings. Shares knowledge and experiences gained from own clinical nursing practice and education relevant to nursing, discharge planning and case management, and utilization management.
*Participates in the orientation and training of other staff. May serve on committees, work groups, and task forces at the facility.
*Must maintain a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional nursing; the Case Management Society of America (CMSA); American Accreditation Healthcare Commission/Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health Services Inspection (HSI); and other applicable DoD and Service specific guidance and policies. Must also comply with the Equal Employment Opportunity (EEO) Program, infection control and safety policies and procedures.
*Follows applicable local facility/AF/DoD instructions, policies and guidelines.
*Completes medical record documentation and coding, and designated tracking logs and data reporting as required by local facility/AF/DoD instructions, policies and guidance.
*Completes all required electronic medical record training, facility-specific orientation and training programs, and any AF/DoD mandated training.
Qualifications:
Requirements:
*Must have the knowledge and ability to effectively apply the following core discharge planning and case management functions: a) Assessment: Assesses every inpatient and same day surgery patient for discharge planning needs; b) Referral: Considers all needs for referrals to include TRICARE authorizations, durable medical equipment, special needs equipment/services, ongoing specialty medical care, case management, institutional referrals such as transfers for rehabilitative or nursing home care; c) Formulation: Collaborates with the provider and other members of the healthcare team as needed to determine the best discharge plan for the patient; d) Implementation: Reviews the discharge plan with the patient and the patient�s family/caregiver prior to discharge and documents the review in the patient�s medical record; e) Montoring: Documents and updates the discharge plan as needed in accordance with local facility/AF/DoD policies and guidelines. Conducts periodic evaluations of the quality and effectiveness of the discharge planning process.
*Must be knowledge in medical privacy and confidentiality (Health Insurance Portability and Accountability Act [HIPAA]), and accreditation standards of Accreditation Association for Ambulatory Health Care (AAAHC) and The Joint Commission (TJC); computer applications/software to include Microsoft Office programs, MS Outlook (e-mail), and internet; problem-solving skills to articulate medical requirements to patients, families/care givers, medical and non-medical staff in a professional and courteous way; DRGs, ICD-9, CPT-4, HCPCS coding; and concepts Length of Stay (LOS) and Avoidable Bed Days.
*Must have the ability to communicate effectively both orally and in writing; apply critical thinking skills and expertise in resolving complicated healthcare, social, interpersonal and financial patient situations;
*Education. Shall be a graduate from an associate�s (ADN) or baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education.
*License. Maintain an active, valid, current, and unrestricted license (with no limitations, stipulations or pending adverse actions) to practice nursing as a registered nurse in any US state/jurisdiction.
*Experience. A minimum of 3 years for ADN/2 years for BSN full-time experience in clinical case management or discharge planning for adults, children, families, seniors and groups.
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