Registered Nurse: Care Management, Acute (Allina)

Description

About us:

Navvis is a leading population health company, driving performance in value-based care. As an operating partner to some of the country’s most innovative health systems, physician enterprises, and health plans, we provide solutions that accelerate the journey to value-based care. Our approach is market-based – we respect the unique needs of populations in each community, including access to care, culture, values, and capabilities. Together with our partners, we set a new national standard in healthcare performance that delivers the affordability, quality, access, and experience that all patients deserve.

www.navvishealthcare.com

Department overview:

What if we routinely asked every person involved in providing or receiving care: "What matters to you and why?" How would understanding "what matters" enhance our ability to transform health in communities and strengthen the connective process, leading to deeper levels of interaction and integration? We are deeply passionate about understanding what matters to people to ensure the delivery of Real-Person Care. We create an ecosystem that builds a foundation for better physical, social, and emotional health. Our Care Solutions, Analytics, Implementations, Clinical and Business Operations, and Learning and Development teams work tirelessly in partnership with our clients and stakeholders in communities to address the real-life healthcare needs people have every day.

This position will work Monday to Friday (daylight hours) within a hospital. This on-site role is based in Minneapolis.

Focused on Allina Health Metro Hospitals, as the Next Site of Care Nurse-Coordinator, you will:

• Work with site Case Manager lead to identify patients with potential Transitional Care Unit (TCU) discharge disposition to TCU
• Work with Unit Case Management to facilitate appropriate next site of care discussions
• Identify units with highest volume of patients intended for Transitional Care Unit discharge and engage patients and families in discharge planning
• Touch base daily with Unit Case Management to facilitate appropriate next site of care discussions
• Function as Next Site of Care Decision Subject Matter Expert
• Function as dyad with transition of care managers (TOCMs)
• Communicate with Post-Acute Care Transition of Care Managers regarding patients appropriately intended for Transitional Care Unit Admission to ensure timely and safe transition
• Introduce Ambulatory Care Management Services to patient and ensure warm hand-off
• Participate in multidisciplinary rounds when possible
• Develop and drive action plans for performance improvement
• Escalate cases to Physician Advisors (or others) when disposition disconnect occurs
• Study and observe industry trends and offer suggested improvement ideas for discharge decisions tools, programs, and processes
• Monitor updates related to discharge decision tools, programs, and processes from NCQA, CMS, Joint Commission, IHI, etc. and provide overview to team members
• Plan, coordinate, develop and deliver high-quality, specialized documents, written reports, and presentations for client organizations
• Participate in sub-committees as appropriate (Care Transitions)

A day in the life:

• The Next Site of Care Coordinator will work with site Case Manager lead to identify patients with potential Transitional Care Unit (TCU) discharge disposition to TCU
• Attend multidisciplinary rounds (MDRs) when able to do so

What success looks like in this role:

• Seen as a “value-add” team member to client partner Hospitalists, Case Managers, Social Workers, Nursing Staff, Therapy Services, Post-Acute Care Partners, etc.
• Utilization targets exceeded – lowered Transitional Care Unit utilization appropriately and improved utilization of PAC Preferred Networks

Requirements

We are excited about you if you have these things:

• Bachelor’s degree in healthcare related field
• 5 years of operational or clinical experience in Inpatient Care Management or Discharge Planning services
• Registered Nurse licensed to practice in Minnesota
• Organizational skills, with an ability to prioritize multiple asks and deadlines
• Strong leadership skills to achieve buy-in and collaboration toward objectives
• Ability to work effectively independently and as part of a team
• Strong critical thinking, problem identification and problem resolution skills
• Superior verbal and written communication skills
• A focus on detail and accuracy of work
• Experience with Microsoft Office, Word, PowerPoint, Ex