Overview

Job Summary

Provides oversight of clinical services provided in compliance with accepted standards of patient care as determined by State Regulations, Joint Commission, Professional Clinical Board Practice Acts and Service Line Policy and Procedures. Ensures appropriate, qualified and timely resource management in order to meet patient needs and branch financial, operational and quality goals. Works collaboratively with the leadership to improve care and services throughout the organization and ensure operational/financial efficiency and effectiveness.

Essential Functions

• Provides clinical administrative support, clinical expertise to meet patient and staff needs and functions as the liaison with physician practices and hospital case management and other referral sources.
• Analyzes the data to prioritize multi-issue situations to support appropriate actions based on the criticality of patient health and welfare, patient/staff safety and impact to effective, timely services.
• Identifies barriers to situation/complaint resolution and follows-up with the appropriate resources or leadership to address timely and effectively.
• Reviews and supports the development of patient specific clinical plans of care that is effectively communicated with the parties involved and supports quality patient outcomes and patient satisfaction.
• Supports clinical staff in the implementation of the identified plan, coordination of care delivery, and strategies to promote health and safe outcomes.
• Evaluates progress toward attainment of outcomes through documentation review, interdisciplinary team meetings and/or case conference.
• Supports billing compliance and timeliness by maintaining current knowledge of payer requirement and billing criteria, state and federal regulations, performing timely completion of CSC workflow and identifying opportunity for appropriate reimbursement.
• Delegates elements of care to appropriate healthcare workers in accordance with any applicable legal or policy parameters or principles.
• Collaborates with healthcare consumer, family, and others in the conduct of clinical practice.
• Utilizes appropriate resources to plan and provide clinical services that are safe, effective, and financially responsible.
• Participates in committees, shared governance, or other facility decision making activities.
  

Physical Requirements
Primary work is in the office environment. Requires long periods of sitting and computer work. Work may require walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling. Must be able to lift and support the weight of 35 pounds in handling patients, medical equipment, and supplies in the home/facility setting. Must speak English in good, understandable terms. Intact sense of sight, hearing, smell, touch. Finger dexterity. Critical thinking and ability to concentrate. Must be able to respond quickly to changes in patient conditions.

Education, Experience and Certifications

Graduate from an accredited School of Nursing. BSN preferred. BLS required per policy guidelines. One-year experience in a related field required. Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside or; if declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state; or for Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works. Must maintain current state driver's license and auto insurance at all times. Additional education, training, certifications, or experience may be required within the department by the nurse leader.