Employment Type:Full timeShift:Description:ESSENTIAL FUNCTIONS:· Completes a comprehensive assessment of the client’s holistic health status and needs to include clinical condition, support systems and resources, client/family knowledge, perception and adjustment towards disease process, and community resources.· Screens patients/clients for identified and potential needs. Makes referral to appropriate multi-disciplinary services.· Documents case management plan to include: assessment, client/family participation and understanding, consult referrals and discharge plan of care.· Educates staff, clients/families, and medical community on care coordination and regulatory issues that impact care and outcomes.· Documents clearly and timely in the Electronic Health Record and other required systems to insure effective communications along the continuum.· Collaborates with Utilization Management staff regarding payer information, level of care and status determinations for patients.· Understands and self manages to support facility/CIN level success goals; including improvements in quality, cost of care and member experience for the facility/CIN’s population.· Identifies opportunities for improvement (at individual, facility/CIN levels and actively works with healthcare and facility/CIN team to correct or improve results.· Develops and utilizes tools available to effectively evaluate, summarize and communicate patient’s progress toward outcomes to members of the healthcare team and patient and family.· Has a working knowledge of financial and reimbursement processes Medicare DRG payment, Case Rates, Managed Care Risk Contracting, etc.· Coordinates and conducts patient care rounds and family conferences.· Collaborates with Unit Director in strategies/tactics to achieve unit based goals such as quality, financial, and safety indicators.· Demonstrates a wide theory/research base that supports sound clinical and psychological orientation. Specific knowledge regarding pathophysiology, natural history of disease processes, and impact on functional ability and level of care.· Serves as a professional role model/mentor and change agent to develop and assist others.· Other duties as assigned by CIN Director/Care Management/Social Services Manager.MINIMUM KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:· Possession of a current or compact state license as a Registered Nurse issued/defined by the State of Iowa· Three years RN or Care Coordination experience, required.· Bachelor’s degree in nursing or actively pursuing (at least six credits per year). A Bachelor’s degree in a related field is also acceptable. .· Proof of completion of Mandatory Reporter abuse training specific to population served within three (3) months of hire.Our Commitment to Diversity and InclusionTrinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.Our Commitment to Diversity and InclusionTrinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.EOE including disability/veteran
