RN-Coordinator Job Description
RN-Coordinator Duties & Responsibilities
To write an effective rn-coordinator job description, begin by listing detailed duties, responsibilities and expectations. We have included rn-coordinator job description templates that you can modify and use.
Sample responsibilities for this position include:
RN-Coordinator Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for RN-Coordinator
List any licenses or certifications required by the position: CPR, NCQA, PCMH, BLS
Education for RN-Coordinator
Typically a job would require a certain level of education.
Employers hiring for the rn-coordinator job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Education, Management, Science, Associates, School of Nursing, Graduate, Communication, Health, Healthcare
Skills for RN-Coordinator
Desired skills for rn-coordinator include:
Desired experience for rn-coordinator includes:
RN-Coordinator Examples
RN-Coordinator Job Description
- Contacting pharmacies for patient refills
- Perform patient assessments in order to implement best Plan of Care
- Coordinate resources and services for assigned case load
- Work with the patient, family and physician
- Maintain up-to-date / accurate documentation for assigned cases
- Maintains a cooperative relationship among health care teams
- Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of all hospital admissions
- Performs concurrent clinical review for patients to ensure that extended stays are medically justified and are so documented in patient's medical
- Ensures prior authorizations are entered into the UM Module for those services requiring prior authorization from the patient’s third-party payer
- Performs concurrent review of acute and sub-acute services, precertification review for all services following the plans authorization guidelines
- At least 3 years nursing experience prior to care coordination required
- Must have the ability to design and develop performance measures, experience in data analysis and statistical processes, experience in providing education and presentations policy and procedure development
- Document all requests in appropriate systems
- Work with management to overcome any barriers to retrieving medical charts
- Maintain applicable retrieval, completion and accuracy standards
- Graduate of an accredited School of Nursing, Bachelor's Degree in Nursing or plan for completion of BSN
RN-Coordinator Job Description
- Thorough knowledge of how to navigate through an electronic health record
- Manages a coordination of care model for each assigned patient that is cumulative, complimentary and contiguous
- Manages a coordination of care model for each assigned patient that is cumulative, complimentary and contiguous
- Performs an initial assessment of patients within 24 hours of admission focused on immediate short term and transition of care needs to drive expected length of stay consistent with the patient’s working DRG
- Confers daily with the attending physician and consulting physician(s) to review and clarify clinical and utilization appropriateness of the treatment plan for assigned patients
- Works in conjunction with Utilization Review Team to confirm expected LOS and payer approved days
- Documents Avoidable Days within the Cerner UM Module and identifies the correct category for tracking all avoidable days
- Collaborates with the physician and other members of the healthcare team to appropriately achieve the targeted LOS
- Visits patients routinely to complete and maintain an assessment that accurately reflects the patients’ condition and response to the plan of care
- Follows through with planned interventions and documentation to assure appropriate use of health care resources and take appropriate action to facilitate discharge when a patient fails to meet medical necessity criteria, including independently in identifying the need for HINN, HRR, and IM
- Proficiency in database, spreadsheet, and word processing software applications essential
- Registered Nurse in the State of Ohio and a graduate of an approved school of professional nursing or a Licensed Practical Nurse in the State and a graduate of an approved school of practical nursing
- Meets all federal and state standards of education and/or licensure to practice as a Registered Nurse or Licensed Practical Nurse
- Current State of Ohio License as a Registered Nurse or licensure as a Practical Nurse (LPN)
- Years of experience in a healthcare office setting
- Working knowledge of current heart failure care and advanced treatment options, one-year experience preferred
RN-Coordinator Job Description
- Review cases where patients and/or family would benefit from counseling required to complete complex discharge plan with social worker
- Assures that the patient progresses through the continuum of the treatment care and discharge
- Oversees the appropriate use of health care services and maintain cost effectiveness
- Consults/confers with physicians and medical center staff regarding the patient's medical situation, his/her psychological adjustment to illness/disability and/or continuing care needs
- Monitors & develops interventions to positively impact on HCAHPS Discharge Domain – help at home – results
- Work with hospital counterparts following patient discharge
- Ability to assist patients with navigation of the provider network and other community based organizations based on their needs
- Maintains comprehensive knowledge of payer and regulatory requirements with ability to work effectively under pressure
- Collaborates with interdisciplinary teams and leaders (PSG, SPA, Quality, ACO leaders and care coordinators, and Govt Programs) to achieve the organization’s coordination of care goals, quality goals, and financial performance goals
- Prepares and maintains care coordination reports and prepares periodic reports for senior management, as required
- Lift thirty pounds or more four or more times/hour
- Communicate via telephone and other automation devices
- Operate personal computer and word processing program
- Use of PDA device
- Visualize computer screens, medical records, forms, and equipment screens
- Must be a Registered Nurse from an accredited school of nursing and be licensed to practice professional nursing in the State of Ohio
RN-Coordinator Job Description
- Request and review member medical records for potential exclusions from HEDIS measure
- Coordinate all physician and hospital investigation with Network Management Department for a consistent provider approach
- Maintain evidence of investigation and changes for each HEDIS measure and member
- Support annual HEDIS auditing process by maintenance of all data and process controls
- Review and evaluate clinical documentation submitted by network providers through the IKA ProHEDIS tool for HEDIS measure compliance
- Annually finalize the review and investigation of members non compliant for HEDIS measures for the calendar year before HEDIS submission requirement
- Day to day coordination and completion of clinical and administrative HEDIS rate clean -up processes
- Establish and maintain detailed work strategy for each clinical HEDIS measure to improve administrative rate and validate clinical exclusions
- Implement process to request and evaluate member reports for each HEDIS measure
- Maintain detailed database for HEDIS rate investigation and validation activities, calculate HEDIS rates based on administrative and clinical changes
- Must have excellent organization and problem solving abilities
- Must be a team player, flexible and able to handle multiple tasks
- A current, unrestricted DE Nursing license is required
- LPN with current state licensure.Preferred RN with current state licensure
- New Jersey RN Licensure required
- Requires working under stressful conditions and working irregular hours
RN-Coordinator Job Description
- Coordinate validated changes with IT HEDIS team for integration into HEDIS system reporting
- Coordinate electronic reporting from Health Plan clinical areas on members who are potential exclusions or compliant with HEDIS measures, investigate each member through established process
- Coordinate with Pharmacy Department on-going process for data requests regarding potentially missing pharmacy claim information for specific HEDIS measures, or members exhausting their pharmacy benefit
- Provide all appropriate Health Plan departments and senior management monthly updates on rate clean up and validation process and results
- Responsible for preparing and submitting the magnet application, designation and re-designation processes for the hospital
- Must fully research magnet standards and be accountable for identification of exemplars and collection of evidence, application development, writing and submission of all required documents
- Facilities understanding and integration of magnet recommendations into nursing practice and outcome achievement
- Ensures alignment of structures and processes for achievement of magnet standards and performance across the hospital
- Serves as a magnet adviser to the hospital nursing and administrative leadership team and nursing staff
- Facilitate and oversee the preparation of all magnet documentation
- Registered nurse, minimum of 5 years of health care related experience required
- Proficiency in Microsoft Word, PowerPoint, Excel, and Access preferred
- Working knowledge of the National Committee on Quality Assurance (NCQA) HEDIS requirements a bonus, but not required!
- 3 plus years of experience as a practicing Registered Nurse in operating room, procedural, case management, or ambulatory care
- Mother/Baby or Ortho/Spine experience preferred
- Acute cardiac experience, cardiac certification preferred