<p>Job Summary</p> <p>Develop, implement, and sustain the disease management program for the total joint disease management program across the continuum of care. Design and analysis of utilization opportunities, development of strategies to decrease utilization, development of staff to coordinate the total joint patient admissions, discharges, collaboration with physicians to change practice patterns, and negotiation with payor for certified days of care.</p> <p>Responsibilities</p> <ul> <li>Collaborate with attending physician regarding application of appropriateness criteria, coordination of care from pre-admission through discharge planning process. </li><li>Provide patient/family information regarding services available to aid family/patient in making informed decisions. </li><li>Complete the pre-admission screening, document pre-admission form prior to admission: identify patient goals; assess discharge plan and resources; verify family support; identify payment source; and obtain insurance approval/pre-certification. Assure that all requirements are met for admission. </li><li>Facilitate the timely implementation of the plan of care in collaboration with the multidisciplinary team. Serve as a liaison to ensure that all elements critical to the plan of care have been communicated to the patient, family, and members of the multidisciplinary team. </li><li>Educate multidisciplinary team regarding documentation in order to ensure continuity of care and hospital/physician reimbursement for all services rendered. </li><li>Interface with attending and consulting physician, residents, staff nurses, and other members of the multidisciplinary team to address system processes which impact the timely facilitation and delivery of care. </li><li>Collaborate with all members of the multidisciplinary team to facilitate the care of the patient. Monitor patient progress on a routine basis, intervening as necessary and appropriate, to ensure the plan of care and service provided are patient focused, high quality, efficient, and cost effective. </li><li>Assist the physician with patient progress for the Total Joint Program manager/medical director for Orthopedics Acute Care Unit, collaborate with multidisciplinary team to identify patient needs, assess patient progress, address family and patient needs and make appropriate referrals to address those needs. </li><li>Provide continuity of care by frequently communicating with physical therapists, patients, family, and physician. </li><li>Communicate with administration and physician regarding specific patient care issues to Total Joint Camp. Communicate with nurse manager of acute care unit and Medical Director regarding specific issues related to skilled nursing issues. </li><li>Act as a link to the community by responding to referrals outside of CAMC within 24 hours from other hospitals, physicians, and individuals. </li><li>Develop a monthly seminar for community education of the Total Joint Camp Program. </li><li>Teach pre-op class twice a week. </li><li>Maintain and distribute daily admission/discharge sheet. Update patient waiting list prioritizing patients and keeping case coordinators, patient, family, and physicians updated to facilitate admission services. </li><li>Participate in various meetings: discharge meetings on appropriate units to ensure/facilitate discharge planning from acute units and that admission to post acute care occurs in a timely manner including communicating with patients, family, and physicians. </li><li>Update insurance companies as required, keeping team members informed. </li><li>Serve as a liaison with the referring physician. </li><li>Provide in-service education and serve as a resource for physicians, residents, medical students, nursing, and other professional staff, and for appropriate consults and patient selection to include clinical readiness for admission to Total Joint Camp Program. </li><li>Demonstrate the ability to effectively communicate both written and orally with appropriate team members, including payors. </li><li>Participate in performance improvement councils in order to share data and develop methods to optimize resource utilization in order to achieve quality outcomes. </li><li>Collect data on patients admitted to Total Joint Camp Program. </li><li>Promote coordination of services to proper patient selection to reduce potential re-admission of high-risk patients. </li><li>Utilize tracking methods to facilitate system changes or change in practice and participate in quality management activities, including screening, focus studies and others. </li><li>Assist with development and tracking of quality indicators and collection of variance data. </li><li>Perform work in a cost-effective manner. </li><li>Participate in continuous, quality improvement activities of the development and institution. </li><li>Develop and conduct in-services and seminars for professional staff as well as the community on Total Joint Program. </li><li>Work closely with Marketing for physician and community education. </li><li>Work with Administration and physicians to develop database on Total Joint Program members. </li></ul> <p>Knowledge, Skills & Abilities</p> <p>Patient Group Knowledge (Only applies to positions with direct patient contact)</p> <p>The employee must possess/obtain (by the end of the orientation period) and demonstrate the knowledge and skills necessary to provide developmentally appropriate assessment, treatment or care as defined by the department's identified patient ages. Specifically the employee must be able to demonstrate competency in: 1) ability to obtain and interpret information in terms of patient needs; 2) knowledge of growth and development; and 3) understanding of the range of treatment needed by the patients.</p> <p>Competency Statement</p> <p>Must demonstrate competency through an initial orientation and ongoing competency validation to independently perform tasks and additional duties as specified in the job description and the unit/department specific competency checklist.</p> <p>Common Duties and Responsibilities</p> <p>(Essential duties common to all positions)</p> <ol> <li> <p>Maintain and document all applicable required education.</p> </li><li> <p>Demonstrate positive customer service and co-worker relations.</p> </li><li> <p>Comply with the company's attendance policy.</p> </li><li> <p>Participate in the continuous, quality improvement activities of the department and institution.</p> </li><li> <p>Perform work in a cost effective manner.</p> </li><li> <p>Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations.</p> </li><li> <p>Perform work in alignment with the overall mission and strategic plan of the organization.</p> </li><li> <p>Follow organizational and departmental policies and procedures, as applicable.</p> </li><li> <p>Perform related duties as assigned.</p> </li></ol> <p>Education</p> <ul> <li>Master's Degree (Required) Education: Master's Degree in Nursing OR Other Related Degree- Meets the Clinical Ladder III Level Experience: 5-7 Years Supervisory and/or Training education experience in Med, 5-7 Years Surgery or Post Acute Nursing Services Substitution: RN Bachelor's Degree with 5 Yrs Additional Experience May be Substituted for RN Master's Degree </li></ul> <p>Credentials</p> <ul> <li>Registered Nurse (Required) </li></ul> <p>Work Schedule: Days</p> <p>Status: Full Time Regular 1.0</p> <p>Location: General Hospital</p> <p>Location of Job: US:WV:Charleston</p> <p>Talent Acquisition Specialist: Lauren R. Lane lauren.lane@vandaliahealth.org</p>