CARE TRANSITION MGR RN

Texas Health Resources - Plano, TX4.0

Part-time
Texas Health Plano seeks to hire a Care Transition Manager Registered Nurse to work Part Time.

The address is 6200 West Parker Road; Plano TX 75093

Salary range is Min. $35.48/hr. to Max. $49.18/hr. – based on relevant experience

Work Schedule

  • Shift is 8AM-4:30PM (3 days a week), part-time, 24 hours per week, weekends and holidays required
The essential job duties of this position are:
Delivers care to patients utilizing the Nursing Process
  • Actively participates in Daily Patient Care Briefings and identifies patients appropriate for transition needs intervention.
  • Reviews Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients. Collaborates with
interdisciplinary team to identify high risk patients whose RRP score may not have indicated appropriately.
  • Ensures all assigned patients have an identified Primary Care Physician (PCP). If PCP not identified, exhaust all efforts in an
attempt to assign.
  • Completes Transition Evaluation on all identified patients within 24 hours of referral; documents appropriately.
  • Interviews/Assesses patients / caregivers as part of transition evaluation and as needed.
  • Identifies transition needs (including medications), develops transition plan within 24 hours of referral, and discusses funding
of post transition care with patients / caregivers; documents appropriately.
  • Validates transition plan with Interdisciplinary Team (Physician, Clinical Nurse Leader, Nursing, etc.).
  • Ensures transition plan and post acute management plan consistency across care settings.
  • Complies with all documentation requirements. Documents all activities in electronic health record.
  • Adheres to compliance requirements: Code 44 intervention, HINN letters, Second IMM, Observation letter, etc.
  • Has working knowledge of Advanced Directives, Living Will, Medical Power of Attorney, Mental Health Treatment Declaration,
  • Out-of Hospital Do Not Resuscitate
  • Order and Advanced Illness Planning
  • Participates in Joint Commission readiness activities
Serves as a content expert on the following:
  • Compliance with program expectations.
  • Mitigation activities with all clinical partners / payors as needed.
  • Compliance requirements: Code 44 intervention, HINN letters, Second IMM, Observation letter, etc.
  • Potential denials, avoidable days, alternate level of care days, etc.
  • Medical necessity criteria, patient status, and discharge criteria.
  • All clinical documentation
  • Clinical Review staff requirements and communications
Qualifications

The ideal candidate will possess the following qualifications
  • Current RN licensure or compact licensure recognized by the Texas Board of Nursing upon hire
  • Bachelor’s degree in Nursing required
  • Minimum 3 years clinical experience as staff nurse at an acute care hospital (required)
  • Minimum 2 years acute care hospital discharge planning/care management (preferred)
  • CPR - Cardiopulmonary Resuscitation
  • ACM - Accredited Case Manager (upon hire preferred)
  • CCM - Certified Case Manager (upon hire preferred)
  • ANCC (upon hire preferred)
Skills
  • Knowledge of Microsoft Outlook and Office (Word, Excel)
  • Competency in medical necessity criteria preferred
  • Customer service skills
  • Ability to engage in complex clinical decision-making
  • Strong oral and written communication skills
  • Strong commitment to interdisciplinary collaboration and communication
  • Strong skills in the preparation of clinically pertinent medical record documentation
  • Critical thinking and analysis skills and conflict resolution skills
  • Position requires flexible scheduling, including weekend and evening shift work as necessary
  • Psychosocial and crisis intervention skills
  • Ability to prioritize and meet deadlines.
  • Preferred experience with electronic health record and automated case management systems.
  • Individual must be self-directed and goal/outcomes/measurement driven
Why Texas Health Resources?
Texas Health Presbyterian Hospital Plano is a 366-bed, Magnet-designated hospital and recognized clinical leader, providing technologically advanced care to Plano, Frisco and surrounding communities since 1991. This full-service facility features a full range of specialties including emergency medicine, cardiology, adult and adolescent behavioral health, pediatrics, an adult intensive care unit, state of the art and technologically advanced surgical services and a Level IV NICU. Texas Health Plano has more than 1,600 employees and over 1,360 physicians on its medical staff in more than 65 specialties. The hospital is an Advanced Level III Trauma Facility, accredited Chest Pain Center by The Joint Commission, named “Best Place to Have a Baby” in Collin County and a Gold-Level Mother Friendly business. Texas Health Plano is the recipient of the Disease Specific Care Certifications from the Joint Commission in Chest Pain, Joint Replacement – Hip and Joint Replacement – Knee and an Advanced Certification as a Primary Stroke Center. We invite you to join us in furthering your career and our accomplishments and philosophy of excellence.

Texas Health Highlights
  • 2018 FORTUNE Magazine’s “100 Best Companies to Work For®” (4th year in a row)
  • 2018 Becker's Healthcare "150 Great Places to Work in Healthcare" (4th year in a row)
  • 2018 Employees’ Choice “Best Places to Work” by Glassdoor