RN Care Coordinator Hospital at Home Enrollment - Days/Every other Weekend

Licensure, Certification, or Registration Requirements for Hire:
Licensed Registered Nurse in the State of Virginia or eligible

Licensure, Certification, or Registration Requirements for continued employment:
Current RN licensure in Virginia Complete 15 Continuing Education Units per year

Experience REQUIRED: Minimum of three (3) years of nursing experience in an acute care setting

Experience PREFERRED:
Academic healthcare experience One (1) year of UM/Care Coordination experience Clinical experience with specialty patient population

Education/training REQUIRED:
Baccalaureate Degree in Nursing from an accredited School of Nursing

Education/training PREFERRED:
Master's Degree in Nursing or a healthcare related field from an accredited program

Independent action(s) required:
Works with the attending and consulting physicians to facilitate effective and efficient transition through the process of hospitalization.
Works collaboratively with all members of the multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted, and that resources are efficiently and effectively utilized.
Seeks the expertise of social workers to resolve psychosocial patient care issues and to develop complex patient transition/discharge plans as needed. Interacts with patients, family members, healthcare professionals, community and state agencies in this effort. Serves as an advanced clinical resource to the team.
Serves as a liaison between the hospital and community agencies or facilities for the exchange of clinical and referral information.
The role is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series and CMS guidelines.
Utilizes medical necessity criteria as a tool to assess appropriateness of level and setting of care, assists in the denial and appeals process, assesses quality and identifies and reports potential risk management issues.
Responsible for participation in and completion of all patient safety initiatives appropriate to the position.
The incumbent conducts all job responsibilities according to VCUHS' Mission and Values.
Responsible for establishing and maintaining a professional rapport with providers, patients/families, and internal customers.

Supervisory responsibilities (if applicable): N/A

Additional position requirements:
Day and Evening shifts available

Age Specific groups served: All

Physical Requirements (includes use of assistance devices as appropriate):
Physical: Lifting 20-50 lbs.
Activities: Prolonged sitting, Walking (distance)
Mental/Sensory: Strong recall, Reasoning, Problem solving, Hearing, Speak clearly, Write legibly, Reading, Logical thinking
Emotional: Steady pace, Able to handle multiple priorities, Frequent and intense customer interactions, Able to adapt to frequent, change

The Hospital at Home RN Care Coordinator promotes and screens inpatient referrals alongside the Hospitalist for enrollment in to the Hospital at Home program. This role is crucial to ensure Hospital at Home patients have a successful, safe, and quality inpatient care encounter.

The screening process includes actively reviewing possible candidates from an EHR pull list through chart review, reviewing referrals from a referral list in the EHR, collaborating with referring providers and the inpatient care management team for referrals, and completing bedside evaluations and education on the program.

Education on the program includes reviewing the program itself, completing a patient care agreement, and educating the patient and/or their caregiver on remote patient monitoring technology that is used during program enrollment.

Lastly this role also ensures that the Hospital at Home patient successfully transfers to their home for program enrollment with the appropriate resources such as DME, food/nutrition, rehab services, medical supplies, and/or transportation.

This role is 10hr day shifts 4-days a week and covers every other weekend. Some flexibility to shift to 8hr day shifts 5-days a week as needed is preferred. No major Holidays are required, however rotating coverage on the Eve and/or day after major Holidays is required.

EEO Employer/Disabled/Protected Veteran/41 CFR 60-1.4.