Wanda Brown

Utilization Management: Assures the patient is in the appropriate status and level of care based on Medical Necessity process and submits for Secondary Physician review per Kaiser policy. Ensures timely communication of clinical data to various payers to support admission, level of care, length of stay and authorization for post-acute services. Advocates for the patient and hospital with payers to secure appropriate payment for services rendered.

· Completion of clinical reviews

· Promotes prudent utilization of all resources (fiscal, human, environmental, equipment and services) by evaluating resources available to the patient and balancing cost and quality to assure optimal clinical and financial outcomes.

· Identifies and documents Avoidable Days using the data to address opportunities for improvement.

· Prevents denials and disputes by communicating with payers and documenting relevant information.

· Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) supported by evidence-based practice, internal and external requirements.

· Identifying appropriate level of care needs

· Assisting with patient transition to the appropriate level of care

· Order clarification admission status and patient classification.

· Maintain and foster timeliness and accuracy with all members if the multidisciplinary team.

· Escalates barriers to patient care as appropriate.

Transition Management:

· Makes referrals for post-acute services based on needs identified by the RN Case Manager or SW staff assessment and utilizing the electronic Case Management system.

· Provides patients and families with choices of post-acute providers per

· Based on SW and RN assessment and plan follows up on readmitted patients and implement strategies to address opportunities outlined.

· Ensures all elements of the transition plan are implemented and communicated to the healthcare team, patient/family and post-acute providers.

· Identifies and reports variances in appropriateness of medical care provided over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes documentation in the Case Management system to communicate information through clear, complete and concise documentation.

Care Coordination:

· Follows up on patients identified by the SW and /or RN Case Manager on factors that may affect the progression of care.

· Ensures consultations, testing and procedures are sequenced to support the patients’ clinical needs with timely and efficient care delivery.

· Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient plan of care.

· Effectively collaborates with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical and transition outcomes.

Education:

· Contributes to the education to patients and the care team relevant to the

· Effective progression of care,

· Appropriate level of care, and

· Safe and timely patient transition

· Provides patients and healthcare team information regarding resources and benefits available to the patient along with the economic impact of care options.

· Ensures that education has been provided to the patient/family/caregiver by the healthcare team prior to discharge.

Compliance:

· Ensures compliance with federal, state, and local regulations and accreditation requirements impacting case management scope of services.

· Adheres to department structure and staffing, policies and procedures to comply with the CMS Conditions of Participation and Kaiser policies.

· Operates within the LVN/LPN scope of practice as defined by state licensing regulations.

· Remains current with Kaiser Utilization Management/Case Management practices

PRIMARY INFORMATION, TOOLS AND SYSTEMS USED:

· Patient data - hospital admission, discharge, transfer system

· Healthcare staff documentation related to patient care.

· Regulatory and payor requirements

· Kaiser Plan benefits

· Health Connect

· Tapestry

· McKesson Care Enhance Review Manager (CERMe) InterQual system

· Clinical data interface and secure faxing

· Patient Medical Record including Health Connect and Tapestry

· Hospital specific Clinical Software

PERFORMANCE METRICS AND EVALUATION:

· The metrics below provide an indication of the effectiveness of the individual in this role and may be used for evaluative purposes. The list below is not meant to be exhaustive; other relevant metrics may exist.

· InterQual reviews

· Observation hours

· Excess Days/ALOS

· Patient Day Rate

· IQM metrics

· Number and type of avoidable days.

· Resource Utilization

• Provides nursing care to patients under the direction of a Registered Nurse, utilizes observational skills to assess nursing intervention and assists medical staff to insure optimal patient care within established policies, procedures and standards
• Provides therapeutic patient care in accordance with the patients established by the physician and a registered nurse within scope of practice.
• Transcribes physicians’ orders as directed by policy.
• Communicates directly with registered nurse to institute changes in plan of care; assists with and contributes to development of nursing care.
• Give specified medication orally, hypodermically, intramuscularly and topically.
• Executes treatments such as urinary catheterizations, bladder irrigations and installations, suctioning procedures, throat irrigations and enemas and utilizing equipment as required.
• Performs related patient care functions such as taking temperature, pulse, respiration and blood pressure readings; applying and removing dressings; may instruct patient in various self-administered treatments or procedures; obtains specimens; assures correct culture collection.
• ·Assists physician or other medical staff personnel with examinations and treatments by selecting and passing instruments, providing support and restraint to patient, draping and other assistance as directed or required.
• Within scope, evaluates patient’s condition by observing signs, symptoms, and reactions to therapy, to identify unexpected and/or significant findings, initiates appropriate emergency procedures as necessary and reports unusual conditions to the registered nurse as established by policy and procedure in a timely manner; maintains intravenous flow rate, performs venipuncture and finger sticks to obtain blood samples, notifies R.N. of any problems and discontinues needles, except intra-Cath and CVP lines.
• Identifies learning barriers.
• Documents patient signs, symptoms, observations and therapeutic treatments to patient’s medical record.
• Ensures cleanliness of nursing module, patient room, and environment and proper functioning of patient care equipment by visual inspection, routine testing, and other related methods.
• Provides a safe and therapeutic environment for patients and staff.
• Utilizes effective verbal and non-verbal forms of communication.

• LPN / LVN administers medication, performs treatments and patient care responsibilities as prescribed consults with and keeps Registered Nurse informed of activities, symptoms, reactions, and changes in the patient’s condition regarding assigned patients
• Provides appropriate pain management techniques and educates the patient and family regarding pain management administers medication following the five rights of medication administration within the scope of practice assists with the rehabilitation and treatment of patients in accordance with the medical plan of care, updates, and revises plan of care under the supervision of Registered Nurse assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills as directed by the Registered Nurse treats patients and their families with respect and dignity
• Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families interacts professionally with patient/family and involves patient/family in the formation of the plan of care assists with admitting, discharging and transferring of patients
• Identifies and addresses psychosocial needs of patients and family; communicates with Social Services/Discharge Planner regarding both in-hospital and post discharge needs.

• Responsible for restoration of patient's health and collaborates with physicians and multidisciplinary team members to provide support to patients Supply and administer medicate
• Record dosages in medical records
• Daily inventory count of medication supply and receiving incoming shipments
• Responsible for safeguarding medication inventory
• Collect fees and perform daily cash reconciliation in absence of the cashier personnel
• Observe / monitor patient demeanor
• Communicate patient concerns to superior
• Comply with federal and state privacy rules, including 42 CFR Parts 160, 164 as well as applicable clinic policies and procedures
• Contact other centers to verify dosages as needed
• Administer appropriate lab tests, collect data and report per process
• Schedule and screen patient to be seen by Medical Director
• Receive and document medical orders
• Actively participate in CAFR preparation and start audit process
• Always act in the best interest of patient, program and company
• Honor, support and protect the proprietary right of patients and company
• Interface with public and patients by answering phones, greeting visitors, and monitoring patient activities while on center premises

• Charted changes in patient conditions and discussed concerns with supervising healthcare provider.
• Addressed patient care needs, collected vitals, dressed wounds and managed catheters.
• Cared for patients' acute and chronic wounds by changing dressings and applying medicated compounds.
• Observed strict confidentiality and safeguarded all patient-related information.

• Provided palliative care for terminally ill geriatric, pediatrics, adolescents and adult patients and family
• Assessed vital signs, and determined what level of care needed
• Administered control narcotics per MD orders
• Assistance was provided with after life care, and mortuary services
• Occasional Blood Draws If needed
• Routine Nursing Assessment

• Provide care and teaching geriatric and pediatric patients / and family at home
• Inspect patient’s environment for possible hazards and dangers, providing specific patient care duties, and educating the patient and any caregivers living in the home about the patient's condition and needs
• Assess what kind of help is needed, help patients find the services they need, create plans for treatment or recovery, work with other health and human service providers, Blood Draws if requested by Primary MD
• Education

• Provided palliative care for terminally ill geriatric, pediatrics, adolescents and adult patients and family
• Assessed vital signs, and determined what level of care needed
• Administered control narcotics per MD orders
• Assistance was provided with after life care, and mortuary services
• Routine Nursing Assessment
• On call visit

• Under direct supervision of Registered Nurse, provides nursing care within the scope of licensure for assigned patients according to established nursing standards and hospital policies and procedures
• IV Blood Draws
• Administers medication, performs treatments and patient care responsibilities as
  prescribed
• Consults with and keeps Registered Nurse informed of activities, symptoms, reactions, and changes in the patient's condition with regard to assigned patients
• Provides appropriate pain management techniques and educates the patient and
  family regarding pain management
• Administers medication following the five rights of medication administration
  Within scope of practice
• Treats patients and their families with respect and dignity
• Identifies and
  addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients

• Assigned a variety of tasks, starting with maintaining proper safety procedures
• Duties include properly monitoring medical supplies, like needles and medication
• Limit the use of potentially dangerous materials, like scalpels and intravenous drips
• Aside from an emphasis on the safety of medical professionals, carefully monitor patients' progress and responses to medical treatments, as well as administer medication and maintain disease clinics
• Properly document patient medical histories.

• Assessment and Performance Improvement/ LVN Visit Nurse
• The QAPI Coordinator has the overall responsibility for the development and implementation of the QAPI program
• Reviews hospice medical records for assessment of the quality of clinical services to ensure adherence to all policies and procedures and applicable standards and makes recommendations for changes in policies, procedures, systems and for staff education
• Supervise Medical Records
• Works with the Administrator to provide an on-going, comprehensive
  assessment of the quality of care and services provided
• Coordinates the implementation of the program’s Quality Assessment and Performance Improvement Plan to assess the quality and appropriateness of patient care
• Coordinates all QAPI audits and studies as indicated in the plan
• Develops and implements problem focused audits
• Reviews all incidents, concerns and grievances to ensure appropriate follow-
  up
  and documentation have occurred
• Identifies patterns and trends and reports them to the Administrator and QAPI
  committee
• Administers prescribed treatments and medications as permitted by scope of
  practice
• Provides those services requiring nursing skills in accordance with the plan of
  care
• Demonstrates flexibility in patient scheduling and readily accepts new
  assignments
• Observes for safety hazards in the patients and organization’s environments
  and takes appropriate steps to reduce or eliminate the problem
• Charted changes in patient conditions and discussed concerns with supervising healthcare provider.

• Provided care and medication administration to geriatric patients
• Gave specialty care for patients with; trach/vent, g-tube, colostomy and ng-tube
• Administer medications via G-tube, NG-tube, PO, IM and Sub-Q
• Supervised certified nursing assistants in providing proper and safe care
• Routine skin assessments and daily dressing changes
  
• Computerized medication orders
  

• Performed nursing tasks to deliver high level of care and comply with procedures and regulations.
• Assessed prisoners suffering injuries through falls, stabbings or other means and stabilized each prior to transport to nearest medical facility.
• Maintained staff safety during prisoner treatments by observing all security procedures and regulations.
• Identified issues related to mental health conditions and recommended specific therapies for patients.
• Documented patient medical histories, current symptoms and vitals.
• Charted changes in patient conditions and discussed concerns with supervising healthcare provider.

• Admission assessments and documented patient history and medication lists, assessed individual conditions and needs for psychiatric patients
• Prepared medication and assisted psychiatric during patient treatment meeting
• Monitored patient reactions to drugs and carefully documented progress of individuals participating in clinical trials
• Monitor youth counselor interacting with patients while on unit
• Monitor patient's Behavior on unit and redirect as needed

• Delivered a complete range of LVN services and expertise
• Accurately obtained and documented patient history and medication lists, assessed individual conditions and needs for psychiatric patients, and selected departmental referrals for acute and chronically ill patients
• Maintained a high degree of accuracy to achieve optimal patient acuity
  monitoring
• Significantly improved facility’s public image by ensuring exceptional patient
  satisfaction
• Supervised and educated medication techs on medication monitoring and side
  effects