RN-Care Job Description

RN-Care Job Description

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Rn-care provides consulting to clinical delegates on a variety of topics including utilization management, case management, disease management programs, and operational processes, including sharing best practices.

RN-Care Duties & Responsibilities

To write an effective rn-care job description, begin by listing detailed duties, responsibilities and expectations. We have included rn-care job description templates that you can modify and use.

Sample responsibilities for this position include:

Provides utilization management and issuance of appropriate authorizations for covered services
Stays abreast of changing length of stay, readmissions, case management, regulatory matters and third party payer requirements
Informing members and providers of Utilization Management determinations and treatment alternatives
Performing all Utilization Management activities in compliance with all regulatory agency requirements
Conducting medical record reviews as appropriate to case management functions
Telephonic contact and/or face-to-face to instruct the patient on how to access the program resources, suggest and/ or arrange follow-up including mailing of educational materials, contact with community resources, and physician follow up visits
Review and evaluate the assessment and SAAM/UAS-NY information
Develop a working relationship with the PCP to be able to contact and discuss care of the member with the PCP
Review assessment findings risk categories with PCP to identify any concerns that have not been identified
Identify the risk factors and assign the risk category to the member

RN-Care Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for RN-Care

List any licenses or certifications required by the position: BLS, CPR, ACLS, BCLS, MLTC, UAS, NYSDOH, CCM, NCQA, PCMH

Education for RN-Care

Typically a job would require a certain level of education.

Employers hiring for the rn-care job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Nursing, Science, Education, Associates, Management, Graduate, School of Nursing, Communication, Healthcare, Arts

Skills for RN-Care

Desired skills for rn-care include:

Community resources
Case management
Utilization management
Specialty area
Managed care principles
Case management and healthcare provided throughout the continuum
Physical and psychological characteristics of disease processes
Pro-active way
Recognizes potential clinical problems
Recommends intervention in a preventative

Desired experience for rn-care includes:

Develop each individual member's disaster plan with the team
As part of Care Management team, develop a formal care plan for all services needed for the member
Monitor the condition of members by phone or, when necessary, face to face
Identify clinical issues that require immediate clinical assessment and/or treatment to reduce risk of unnecessary hospitalizations, ED visits or nursing home admissions
Prior approve requests for additional services based on assessments and using evidence based standards refer denial, reduction or limitation of service requests to the Medical Director
Assist members with the coordination of services both within network and outside network as appropriate

RN-Care Examples

1

RN-Care Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of rn-care. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for rn-care
  • Providing skilled nursing care that conforms to the agency's policy and procedures and established professional standards of care
  • Regularly conducting Case Conferences and maintaining communication with Clinical Managers and other members of health care team
  • Documenting care provided as per the agency's policy and procedures
  • Refers patients to a variety of resources including, but not limited to, nutrition, social work, rehabilitation, behavioral specialist, diabetes education, Healthy Living Workshop
  • Participates in committees and activities related to the development of Medical Home
  • Assesses and interprets patient status/information based on knowledge of growth/development and age
  • Recognizes basic changes in patient condition based on assessment
  • Prioritizes, initiates, and delegates appropriate interventions based on assessed patient needs
  • Demonstrates knowledge of basic arrhythmias
  • Completes all patient care documents according to policy (i.e., Nurses Notes, Admission Assessments, MAR's, etc…)
Qualifications for rn-care
  • Must be knowledgeable of nursing and medical practices and procedures
  • Prefer a minimum of two years of professional nursing experience in an Emergency Room or Urgent/Immediate Care setting is required
  • Bachelors of Science in Nursing from an accredited nursing school, college, or university
  • Must have and maintain current license as a Registered Nurse in Rhode Island or current compact RN license
  • 2-3 years of clinical experience in certified a certified home health agency (CHHA) and/or MLTC
  • Meets and greets new patients to facility
2

RN-Care Job Description

Job Description Example
Our growing company is searching for experienced candidates for the position of rn-care. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for rn-care
  • Keeps patient informed of their rights as a patient, including delivering the Important Message (IM) from Medicare
  • Communicates discharge requirements with patient and notifies patient when their continued hospitalization is no longer meeting medical necessity for the hospital level of care
  • Identifies the need for patient notifications
  • Conducts a review of the clinical condition of assigned patients prior to daily discharge rounds
  • Identify patients who will benefit from the assistance of financial counselors and ensure the hospital’s financial counselors or outside contractors are consulted on the patient and follow-up to identify potential opportunities for financial assistance
  • Collaborates with the patient, the patient’s third-party payer and Utilization Review Team to identify post-acute care options that meet patient needs and assist with information necessary for the Utilization Review Team to obtain timely authorization(s) for services both during and after the patient’s hospitalization
  • Interacting and obtaining relevant clinical information from member's PCP and other providers
  • Approving care that meets established criteria and referring all other cases to the Physician Advisor / Medical Director
  • Performs initial CM assessment and initial utilization review for Emergency Department patients who are to be placed in Observation or Admitted to Inpatient
  • Disease processes and treatment plans
Qualifications for rn-care
  • Must be able to read, write and communicate with patients
  • Must have correctable vision and correctable hearing to be able to hear normal conversations
  • Must present a professional appearance at all times and attend staff and agency meetings, as requested
  • Valid License as an LPN in the state of practice
  • Must have a minimum of one (2) years of nursing experience in Wound Care
  • Cardiac Care Experience preferred
3

RN-Care Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of rn-care. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for rn-care
  • Minimum of one year (1) experience with case management required
  • Maintains awareness of regulations, keeping abreast of pending and or implemented changes and communicates changes to Director of Care Coordinator
  • Perform related work and additional duties as requested by supervisor
  • Serve as clinical faculty preceptor for students rotating at WDI from the College of Graduate Nursing (CGN) seeking an MSN or DNP, for students rotating from other health professions colleges, to experience longitudinal real-world care coordination, integrated team-based care, patient and staff education, and transitions of care
  • Support patient self-management of multiple chronic health and psychosocial conditions to promote improvement in health outcomes
  • Promote empowerment of patients and their families to better understand their health condition, engage in health-seeking behaviors and prevent disease complications
  • Help provide team-based, whole-person, patient-centered care across the continuum of care
  • Utilize all relevant electronic and non-electronic health data systems to communicate across multiple providers both within and outside the WDI
  • Assist patients in qualifying for support services and other programs available in the community
  • Lead and coordinate weekly WDI IPU team care-planning meetings
Qualifications for rn-care
  • Current Ohio license as a Registered Nurse
  • Maintains BCLS and other certifications required by the job, ACLS
  • Initiates emergency care as necessary
  • Current and unrestricted State of Michigan Nursing License
  • Current AHA BLS Certification is required
  • Must be able to generate written communication that is clear, concise, and well-organized
4

RN-Care Job Description

Job Description Example
Our growing company is looking to fill the role of rn-care. If you are looking for an exciting place to work, please take a look at the list of qualifications below.
Responsibilities for rn-care
  • This RN Case Management role, while largely embedded (on site) in the physician offices, providing face to-face interaction with patients and their care team will also outreach to patients telephonically when appropriate to improve patient care
  • Obtain health history information, take accurate vital signs, and review medications
  • Assist with office procedures
  • Provide care that is based in the nursing process and is consistent with the California Nurse Practice Act, the American Nurses Association (ANA) Scope and Standards, and the ANA Code of Ethics
  • Participate in and lead clinical teams
  • Supervise, assign, or delegate to licensed vocational nurses (LVN), unlicensed assistive personnel, and other caregivers as needed
  • Promote client's independence by establishing goals, teaching clients, families and caretakers to understand condition, medications and self-care skills
  • Obtain necessary consents
  • Resolve client problems and needs by utilizing multidisciplinary team strategies
  • Document client care services by charting in patient and department records
Qualifications for rn-care
  • Must have excellent organizational skills and be efficient in prioritizing and managing time and assignments
  • Completion of nursing degree from an accredited college/university
  • We are willing to train graduates with a degree in nursing who lack work experience as long as the following educational requirements are met
  • Working knowledge of electronic medical records, medical terminology, ICD-10, CPT 11 coding, HEDIS measures, and medical office processes (preferred)
  • Clinical experience working with complex populations, including those with physical health, behavioral health, long-term services and supports and/or psychosocial needs
  • Must be confident in your IV skills
5

RN-Care Job Description

Job Description Example
Our innovative and growing company is looking for a rn-care. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for rn-care
  • Supervise overall resident care for a specific group of residents within scope of practice according to licensure
  • Contact other members of the healthcare team as needed
  • Report to the C.N.A.'s and gain a return report from the C.N.A.'s during the shift
  • Assess residents within the scope of practice according to licensure
  • Update the care plan as changes take place and at least quarterly
  • Effectively manages the patient population with special attention to detail while providing support, triage and resolution of any issues
  • Serves as a facilitator to providers for resolution of provider concerns, complaints and grievances
  • Participates in the developmental and quality training programs
  • Identifies and coordinates individual care needs based on assessment outcomes
  • Communicates program parameters with providers and patients
Qualifications for rn-care
  • Minimum 3 years clinical experience with focus in managed care, including behavioral health
  • Experience in a Sub-Acute, Long-Term Care, and/or Home Care environment
  • Knowledge of chemistry, math, pharmacology, anatomy, and all body systems
  • Knowledge of emergency procedures and medical intervention techniques
  • Knowledge of infection control practices and their relation to patient care outcomes
  • Knowledge of the principles of electrical safety

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