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PURPOSE AND SCOPE:
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
Promotes quality patient care and ongoing customer support within an acute care setting as an extension of the Acute Care Program monitoring the provision of patient care to ensure compliance with company standards, applicable hospital policies and regulatory requirements. Facilitates acute care coordination and discharge planning working with the appropriate dialysis and hospital personnel. DUTIES / ACTIVITIES
: CUSTOMER SERVICE:
PRINCIPAL RESPONSIBILITIES AND DUTIES
- Responsible for driving the FMS culture through values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships with members of the hospital care team, acute care team, outpatient dialysis community and attending and consulting physicians in the care through effective and timely communication.
- Operates as a clinical liaison to coordinate the patient’s planned care and treatment from inpatient care to outpatient care
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
- Turnaround time for issues/concerns/complaints is within 24 hour of notification.
- Utilizes clinical judgment, independent analysis, critical thinking skills, and detailed knowledge of the acute programs, medical policies and clinical guidelines to identify, review, assess, and assist in coordinating with the hospital and attending physician, the renal patient’s acute care process and discharge planning.
- Determination of Care - Assessment
- Monitors hospital referrals and establishes patients into cohorts as acute, new-onset renal illness, chronic, or end-stage renal disease.
- Assesses renal patients as assigned upon admission (or close to day of admission as possible.)
- Reviews the medical record of the assigned renal patient.
- Visits with the patient conducting the interview and responding to any questions appropriate for the care manager role.
- Completes a renal-focused nurse care management assessment to help identify patients’ renal needs during hospitalization.
- For internal purposes only, establishes estimated length of stay (ELOS)
- Uses the FMS risk stratification tool to establish clinical risk level for re-admission and follows the FMS risk stratification pathway upon discharge.
- Inpatient Care Coordination/Education - for purposes of determining recommendations to hospitals, attending physicians, or health care team as appropriate:
- Throughout hospital stay, applies company selected care guidelines to evaluate level of care for appropriateness.
- Arranges for Treatment Options Program and or provides patients and their families with written and face-to-face education as indicated during hospital stay.
- Assists patients and their families with understanding and accepting their renal diagnosis.
- Applies program pathways and protocols to manage issues where appropriate, and/or make recommendations to attending physicians related to vascular access, anemia management, and other renal specific needs.
- Encourages patient self-management activities that will aid in preventing renal complications such as hyperkalemia, fluid overload, and bone disease.
- Collaborates with attending MD, nephrologist, social worker, dietician, nurse, other hospital discharge planners/case managers regarding all patient renal-related needs and issues.
- Discharge Planning and Quality Control:
- Should the attending physician determine that outpatient dialysis be medically appropriate, the Inpatient Care Manager arranges for an outpatient schedule at the dialysis facility selected by the patient and the attending physician with a goal of avoiding in-hospital dialysis treatments on the same day of discharge and/or an additional day stay within the hospital.
- Reviews renal-related discharge plans with patient and/or patient’s health care decision maker assessing any anxieties or concerns.
- Communicates with outpatient dialysis providers and their representatives regularly including a patient’s anticipated discharge date and needs for ongoing dialysis treatments.
- Facilitates the patient’s transition from inpatient to outpatient dialysis by collecting and forwarding necessary clinical and demographic information to the outpatient clinic.
- Maintain patient admissions and care manager statistics creating monthly reports on specified indicators of renal inpatient care.
- Management program administration:
- Attends monthly meetings with the Hospital Director of Case Management/Discharge Planning or designated hospital staff to ensure program meets needs of hospital and review statistics.
- Participates in hospital training on systems, people, activities, policies and procedures, medical staff rules and regulations.
- Responsible for maintaining and providing means for correspondence from external and internal resources.
- Assesses and identifies processes for improvement opportunities that may assist with minimizing renal patient costs, decreasing renal patient re-admissions and length of stay.
- Attends Region ORM meetings to discuss renal inpatient care management program success.
- Promotes collaboration between outpatient dialysis providers, their representatives and billing groups to ensure timely intake and appropriate follow-up to patients, hospital social workers and case managers, and physicians.
- May intercede in complex situations such as if the patient is a foreign national, or non-insured patient, or patient with a complicated medical history to gather information to provide to other divisional operations departments such as billing groups, and managed care, to expedite and assist with the admissions process. Follows up with the pertinent party(ies), as needed.
- For FMS patients: may relate identified customer service concerns and problems at the clinic level such as situations where patient discharges are delayed, consistently; or additional admission requests that delay the admission process, etc to RVP, Director Operations or Area Manager for action. Provides assistance with resolution as appropriate.
- Maintains current knowledge regarding industry best practices.
- Evaluates, identifies, and recommends systems and practices that would enhance and improve marketing of the FMS Inpatient Care Management program within the division. Implements as appropriate.
- Other duties as assigned
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Day to day work includes desk and personal computer work and interaction with patients, facility staff and physicians. The position requires travel between assigned facilities and various locations within the community. Travel to regional and division offices and Corporate meetings may be required.
The work environment is characteristic of a health care facility with air temperature control and moderate noise levels. May be exposed to infectious and contagious diseases/materials.
- RN nursing degree.
- Current RN license in pertinent states.
EXPERIENCE AND REQUIRED SKILLS:
- 3 years of nursing experience - experience in case management and/or discharge planning preferred.
- Renal nurse for at least 2 years with demonstrated clinical skills within acute, in-center, or home dialysis.
- Excellent verbal and written communication skills - Must be able to communicate with all levels of hospital, outpatient, and administrative personnel, including physician relationships.
- Excellent skills in customer service, continuous quality improvement, relationship development, results orientation, team building, motivating employees, and decision-making.
- Must have working knowledge of the reimbursement and insurance verification process.
- A fundamental knowledge of managed care a plus.
- Must complete the required compliance and FMCNA orientation and training modules and attend ongoing training and development programs within the specified time line.
- Computer proficiencies: Microsoft Excel and/or Access, PowerPoint, Word, Lotus Notes, or other e-mail provider.
- Demonstrated skills in diversity management and performance management.
- Approximately 30% travel required.