RNCase Management at Tallahassee Memorial HealthCare

WHO WE ARE & WHAT WE DOTallahassee Memorial Healthcare (TMH) is a private nonprofit community-based healthcare system that provides care to a 22-county region in North Florida and South Georgia. We are a career destination with over 6000 colleagues who reflect the diversity of our community.TMH is the regions healthcare leader and top provider of advanced care with a 772-bed acute care hospital and the regions only:Level II Trauma CenterPrimary Stroke CenterLevel III Neonatal Intensive CarePediatric Intensive CareThe most advanced cancer heart and vascular orthopedic & surgery programs in the Panhandle.Our system also includes a psychiatric hospital multiple specialty care centers six residency programs and more than 50 affiliated physician practices.HOW YOULL MAKE AN IMPACTYour Role:Performs Minimum Data Set (MDS) case management utilization review quality assurance (QA) and discharge planning duties. Conducts federally mandated patient assessments based on Centers for Medicare and Medicaid Services (CMS) guidelines including appropriate care planning interdisciplinary communication and Agency for Health Care Administration (AHCA) documentation preparation. Promotes wellness.Is responsible for collecting integral data and compiling/transmitting data to CMS. Determine patients needs based upon illness diagnosis prognosis and social support systems. Contacts appropriate agencies to coordinate patient discharges into the community or long-term care settings. Ensures facility compliance with applicable state and federal regulation. Collaborates with other members of the healthcare team.Reports To:Administrator Rehabilitation Center (JC: 013501) with delegation (as needed) to RN/Director Rehabilitation (JC: 030101)Supervises:NoneWHAT YOULL NEED TO APPLYRequired Education:Associate degree in nursing.Preferred Education:Bachelors degree in nursing.Required Experience: One (1) year of relevant work experience.Preferred Experience:Two (2) or more years of relevant work experienceRequired Certification/License/Registry:Florida RN license. Preferred Certification/License/RegistryMinimal Data Set (MDS) certification or ability to obtain certification within one (1) year of employment.-Tallahassee Memorial HealthCare is an equal opportunity employer and drug-free workplace. All employment is contingent upon successful completion of a drug screen background check reference verification health assessment and credential/license verification.Please remove the following from the Your Role section:Performs Minimum Data Set (MDS) case management utilization review quality assurance (QA) and discharge planning duties. Reports to under your role section is Manager for Case Management not Administrator Rehabilitation Center (JC: 013501) with delegation (as needed) to RN/Director Rehabilitation (JC: 030101)Please remove the following under thePreferred Certification/License/Registry section. That is not needed or used in this rrole.Minimal Data Set (MDS) certification or ability to obtain certification within one (1) year of employment.Below is the Key responsibilities for this role:Discharge Planning & Placement CoordinationFacilitate safe discharge placements to Inpatient Rehabilitation (IPR) Skilled Nursing Facilities (SNF) Long-Term Care (LTC) Assisted Living Facilities (ALF) and Independent Living settings.Home Health & Durable Medical Equipment CoordinationArrange Home Health Care (HHC) services and Durable Medical Equipment (DME) directly from the Emergency Department.TransfersAssist with documentation and coordination of hospital-to-hospital transfers.Medication SupportProvide patients with access to medication assistance programs and sign Letters of Agreement (LOAs) for medications when appropriate.Transportation AssistanceCoordinate discharge transportation for patients requiring support.Readmission InterventionsMeet with patients readmitted to the hospital within 30 days to assess contributing factors and develop prevention strategies.Engage with patients who have visited the ER more than once within a six-month period to identify barriers and connect them with appropriate resources.Alternative Discharge PlanningProvide resources and coordinate safe discharge plans for patients presenting as social admissions ensuring non-medical needs are appropriately addressed. Key Skills Project Portfolio Management,Motivational Interviewing,HIPAA,Computer Skills,Intake Experience,Lean Six Sigma,Conflict Management,Case Management,Team Management,Program Development,Social Work,Addiction Counseling Employment Type : Full-Time Experience: years Vacancy: 1