Registered Nurse - Discharge Planner

Work Schedule: Sunday - Saturday, various 4, 8, 10 or 12 hour rotating shifts. On-Call, Call Back and Overtime required Job Specific Details and Tasks: The duties include, but are not limited to the following: • Provides discharge planning services to all individuals admitted to the medical treatment facility (MTF) as inpatients or same day surgery outpatients. Triages discharge planning needs to permit DP to meet the most urgent, unusual needs. Develops template for repetitive DP processes/procedures to maximize efficient delivery of services when DP is overtasked. • Accurately predict discharge/transfer needs to avert unnecessary delay in discharge, or extended Lengths of Stay (LOS) yet achieving a safe/timely discharge. • Facilitates the smooth transition from an inpatient setting to the next appropriate level of care through effective professional coordination with the patient, the patient’s family/caregiver and the multi-disciplinary healthcare team. This coordination includes patients needing consideration for, but is not limited to, acute, chronic, multiple, complex, catastrophic, or life- threatening illnesses; patients having experienced combat stress, residuals of traumatic brain injury; persons experiencing community adjustment problems; addictions; psychiatric illnesses and other health problems. • Collaborates with utilization management, case management, Medical Discharge Planning Social worker and other members of the healthcare team to achieve a timely, appropriate, safe discharge that meets the patient’s needs and is IAW local facility/Air Force (AF)/ Department of Defense (DoD) as well as local and national discharge standards. • The DP nurse assesses, plans, monitors, and evaluates patient care through discharge planning activities; Applies Interqual (McKesson)/Milliman or other facility endorsed in- and out-patient evidence based programs to monitor Length of Stay (LOS) as well as admission and discharge criteria • Actively participates in arranging transfers both into the Mike O’Callaghan Military Medical Center (MOMMC) and to other medical facilities either for care not available at the MOMMC or to a lower level of care. This includes assisting in obtaining authorizations from the primary insurer as well as identifying suitable transport mechanism (ambulance, helicopter etc.) • Surveys the continuum of care for quality of care concerns and reports them to supervisor, physician advisor, Chief Nurse Executive or other interested parties as indicated. • Participates in committee meetings, working groups, process action teams and other groups as indicated/directed. • Coordinates and contacts clinical units responsible for patient care prior to the discharge of the patient from the hospital to ensure that discharge planning requirements have been met, i.e., requirements for durable medical equipment (DME), such as walkers, wheelchairs, oxygen, referral to Case Management, Diabetes Educator, Social Work Service agencies, family counseling, Home Health Care (HHC) and Community Health Service. • Monitors trends in LOS to identify processes which extend LOS beyond community standards, to ensure MTF is aware of trends and to repair processes when possible to expedite safe timely discharges. • Coordinates with third party payers, as well as TRICARE Managed Care Support Contractor (MCSC), to provide requisite clinical information to accomplish authorization for post-discharge needs, within the plan’s benefit. The DP validates the beneficiary’s insurance plan/benefit allowance and when possible ensures the insurance plan is considered by the provider when making referrals for DME/medications/inpatient transfers etc. • Provides on-going education to patients, providers, and staff related to discharge planning/inpatient transfers. • Ensures the MTF staff provides instructions to patient/significant other and/or family members for post-discharge care, self-care/maintaining healthy life styles, appropriate use of medical services and other needs, as indicated. Designs services to meet educational needs of the targeted audience. Emphasizes the preventive, curative, and restorative aspects of instructions. • Educates patient/family on topics beyond the benefit, but appropriate for specific circumstances, such as nursing home placement, group home placement and the like. • Teaches medical students, Residents, Hospital Attending Physicians, novice nurses and other health and allied health personnel about the considerations impacting the discharge planning/inpatient transfer processes.  • Participates in the orientation and training of newly assigned personnel, as appropriate.  • Establishes and maintains good interpersonal relationships with co- workers, families, peers, and other health team members. • Effectively communicate and collaborate with a diverse group of people for the purpose of informing the healthcare team of plans/actions, for teaching/education to benefit the patient/family and organization. Effectively uses appropriate communication format in addressing professional issues. • Perform accurate documentation, both written and electronic, of all activity in accordance with requirements. • Contributes to professional environment using appropriate leadership skills. • May be required to work various shifts or augment clinical nursing support within the Medical Management Department during the absence of other team nurses due to illness, leave or deployment. • Ensures a safe work environment, employee safe work habits and patient safety IAW regulatory agencies, infection control policies, and process improvement initiatives. • Ability to maintain productivity and perform with minimal supervisory [login to view URL] Qualifications: * Degree/Education: Shall be a graduate from a baccalaureate degree (BSN) program in nursing accredited by a national nursing accrediting agency recognized by the US Department of Education. * Experience:  1. Must have minimum of 5 years’ total nursing experience with the last 36 months working in a direct patient care hospital or acute care discharge planning setting. Must have majority of experience in discharge planning for 24 recent consecutive months. 2.  Must have an extensive range of nursing care theories, principles, practices, and procedures, medical practice, TRICARE concepts, principles, and priorities, and extended clinical training and experience, or education, to analyze the full scope of problems associated with providing the best possible care to patients in the most economical manner, and to solve both administrative and professional health care problems. 3.  Must understand the concept of what constitutes “a safe discharge.” Must understand and be able to apply Interqual/Milliman as well as other evidence based guidelines addressing entitlements and LOD. Must have knowledge of relevant laws such as EMTALA (Emergency Medical Treatment and Active Labor Act) and COBRA (Consolidated Omnibus Budget Reconciliation Act), being able to step in to coach providers to avoid violations of national in- and out-patient emergency transfer standards. 4.  Must have extensive professional knowledge and skills of advanced concepts, principles, and practices to perform highly specialized nurse consultant assignments to manage the Discharge Planning Program, provide technical advice to the admissions office, medical clinics, and physicians in providing the best possible care to patients in the most economical manner, and to solve both administrative and professional health care problems. Must have extensive knowledge of physiological/psychological norms as well as deviations from normative functions. Must have current unrestricted license to practice as an RN in Nevada. Must maintain nursing license 100% of the time with no lapse.  5.  Knowledge of TRICARE, Medicare, Medicaid, Third Party Collections, Veterans Affairs (VA) private health insurance policies and procedures to identify practices to instruct and facilitate acute care in an appropriate and timely manner; thereby improving certification approvals for reimbursement.  6.  Working knowledge of DRGs, ICD-9, CPT-4, HCPCS coding, LOS criteria as well as Avoidable Bed Days.  7.  Knowledge of medical facility organization, mission, purpose, philosophy, and objectives as well as those of the ANA and TJC to provide professional nursing consultation to others in the MTF.  8.  Skill in oral and written communication to articulate medical requirements to professional and administrative staff and to present briefings to providers and beneficiaries. 9.  Ability to analyze and evaluate treatment plans and their relationship/appropriateness to diagnoses and to recognize questionable treatment plans.  10.  Familiarity with a variety of computer applications/software to input and extract data from established databases. * Licensure: Possess current unrestricted Registered Nurse license, any state.   Clinical Certification: Certification (preferred) or eligible in relevant specialty, such as Certified Managed Care Nurse through the American Board of Managed Care Nursing or the American Association of Managed Care Nurses or Certified Informatics Nursing, Ambulatory Care Nursing, Medical-Surgical Nursing or Nursing Case Management through the American Nurses Credentialing Center. * Life Support Certifications: Possess current ARC or AHA BLS, PALS, and ACLS certification. * Security: Must be able to pass a Government background check and obtain a Government security clearance.