Content Risk Reviewer Jobs in Rhode Island (NOW HIRING)

SUMMARY:
Summary:
Reports to the Manager or Director of Case Management. Provides coordinated care support to facilitate and expedite patient care services.

Participates in daily rounds and collaborates with the clinical healthcare team across the patient care continuum to include preadmission and post hospital discharge.

As a member of that team, shares responsibility for the implementation of the discharge plan; ensures efficient and effective delivery of patient care services through the appropriate utilization of healthcare resources.

Full time, part time per diem and job share schedules available.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences
Patient and Community Focus and Collaborate
RESPONSIBILITIES:
Responsibilities:
Partners with medical staff and other members of the healthcare team in collaboration with the patient/family to facilitate the plan of care for a defined patient population across the continuum of care.

Identifies a high-risk patient population within the caseload for care management assessment screening and targets interventions in conjunction with the healthcare team within one business day of patient admission
Participates in daily care rounds to collaborate with members of the patient's healthcare team as well as to evaluate and facilitate development and implementation of the discharge planning process.

Develops the initial patient discharge plan and reviews with patient, family members and other members of the interdisciplinary team.

Reassesses the discharge plan daily during collaborative care rounds.
Proactively builds post hospital referrals and sends to the Transition Care Coordinator when indicated to facilitate timely discharge.
Delivers Important Message follow-up notices to all Medicare patients according to CMS regulations.

Follows CMS and DOH regulations in relationship to discharge guidelines and patient rights.
Coordinates the length of stay with the physician care team and patient. Ensures team is informed of insurance qualifiers that may affect the discharge plan.

Discuss approaching discharge readiness of patients. Identify and assess readmitted patients and complex patients in collaboration with members of the healthcare team to coordinate discharge.
Advocates for the patient and advises the patient regarding financial implications of their discharge plan when coordinating care for the patient. Communicates the discharge plan, including post facility agency acceptance, to patients, families and all members of the care team.
Documents final discharge disposition in progress notes.

Develops appropriate patient care reports to ensure safe patient handovers occur as a patient is transferred from one patient care area to the next.

Provides care plan direction for the advancement of a patient care delivery system which supports managed care strategies and decreases readmission risk.
Acts as a change agent by identifying opportunities to improve patient flow and reduce service delays through problem resolution and follow-up.
Demonstrates a fundamental grounding in nursing theory and practice with a clinical background within a defined content area. Remains current on the latest concepts techniques and methods relative to his/her service.
Demonstrates knowledge of federal and state rules and regulations.
Reviews and acts as a change agent by identifying opportunities to improve patient flow and identifies and reduces service delays through problem resolution and follow-up.

Identifies and tracks service and discharge patient delays.
Participates in departmental and/or interdepartmental quality improvement activities as requested: i.e. OpX teams weekly long LOS reviews interdisciplinary rounds readmission reviews. Participates in Orienting of New staff as requested.
Participates in ongoing education-related professional activities and affiliations to maintain an advanced level of knowledge of patient care services third party payer and managed care requirements and case management.
MINIMUM QUALIFICATIONS:
Licensure as Registered Nurse in the State of Rhode Island by the Rhode Island Board of Nursing or licensure as a Registered Nurse in accordance with the Nurse Licensure Compact agreement of the National Council of State Boards of Nursing.

BASIC KNOWLEDGE:

Graduate of a School of Nursing with current license to practice as a Registered Nurse in the State of Rhode Island.
Bachelor's Degree Required

Certification in Case Management by a nationally recognized organization preferred.
AHA BLS Provider Required.

EXPERIENCE:

Three years of clinical experience with recent experience in case management, community case management, patient navigation, or discharge planning is strongly preferred.
Strong analytical and interpersonal skills are required to provide guidance to and communicate daily with healthcare professionals, patients and families.
Must exhibit a collaborative approach and method of communication to interact successfully on as daily basis with a wide and diverse population of both health care providers insurers patients and their families.
Demonstrates knowledge and skills necessary to provide care to patients throughout the life span with consideration of aging processes human development stages and cultural patterns in each step of the care process.
Must be proficient in the use of Microsoft Office software including email and Outlook calendar and have basic keyboarding skills.

WORK ENVIRONMENT AND PHYSICAL REQUIREMENTS:

General hospital environment with occasional stressful conditions associated with patient care.

Risk of exposure to blood borne pathogens and disease is minimized and controlled by adherence to Hospital Infection Control policy and procedures.
Must be able to make hospital rounds through various patient care areas either by walking or through some other mobile means.

Visual acuity and finger dexterity is needed to review and carry medical records navigate through automated system screens and type on a typical computer terminal keyboard.

Lifting of up to 10 lbs. may be necessary to transport items from one care unit to the next.

INDEPENDENT ACTION:

Responds to individual patient-care situations demonstrating knowledge and skills acquired through education certification and work experience.

SUPERVISORY RESPONSIBILITY:
None.

Pay Range: 

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

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