This standardized position description is for an Army Nurse (Clinical/Case Management) at grade GS-12. The nurse serves as a case manager on a multidisciplinary team, providing assessment, planning, implementation, coordination, evaluation and monitoring of patient care. Key responsibilities include developing plans of care for beneficiaries, facilitating communication between healthcare providers, and empowering patients to make informed healthcare decisions. The nurse also oversees nursing practice, develops clinical guidelines, and identifies strategies to improve access, quality and cost-effectiveness of care.
Health Care Integrator Position Description 15 Dec 06doctorcorcoran
The document describes the position of Health Care Integrator at a military medical treatment facility. The position requires a nursing background and experience in clinical settings, case management, and population health. As Health Care Integrator, the individual would lead teams to improve population health, develop metrics to evaluate care delivery, and integrate care across the health continuum through collaboration, education, and data analysis. Key responsibilities include assessing community health needs, coordinating prevention services, identifying high-risk patients, monitoring conditions, evaluating the delivery system, and taking a total community approach to care.
Sheri Cain has over 20 years of experience in nursing, including case management, utilization review, discharge planning, and emergency room nursing. She provides broad nursing care services and develops and implements case management plans in collaboration with healthcare professionals. She promotes integrated services for patients and has strong communication, analytical, and problem-solving skills.
This document is a resume for Brent Salsburey, BSN, RN. It summarizes his experience as a registered nurse over the past 6+ years working in various clinical settings including hospitals, outpatient facilities, and case management. It highlights his strong clinical, assessment and decision making skills in treating a variety of conditions and developing treatment plans. The resume also lists his education as a Bachelor of Science in Nursing from The Ohio State University and certification as a registered nurse in Florida.
- Bridgette Doyle-Handy is seeking a position that utilizes her 1.5 years of emergency medicine experience and 7.5 years of medical/surgical nursing experience.
- She has experience as a charge nurse managing patient volume, documentation, and staff.
- Her resume details over 15 years of nursing experience in hospitals and rehabilitation centers along with various certifications.
This document discusses strategies for engaging healthcare providers in disease management programs when they are also participants, or "members", of those programs. It notes some challenges like maintaining boundaries and roles when providers interact with colleagues. Some effective strategies identified include acknowledging the provider-member's background, allowing input on care plans, using evidence-based guidelines, and having clinical representatives conduct informational sessions for provider-members. Peer support from other provider-members is also suggested. Training and clear communication are important to properly manage these dual provider-member relationships.
This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.
Avery Evans has over 10 years of experience in medical and customer services roles. She has a Bachelor's degree in Psychology and is proficient in Microsoft Office, medical software programs, and operating systems. Her experience includes roles as a Patient Services Coordinator at MD Anderson Cancer Center, Lead Trustee for a church, Research Data Coordinator at MD Anderson, and Health Information Management Clerk. She has strong communication, organizational, and problem-solving skills and experience in scheduling, data entry, maintaining confidential patient information, and ensuring quality customer service.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
Health Care Integrator Position Description 15 Dec 06doctorcorcoran
The document describes the position of Health Care Integrator at a military medical treatment facility. The position requires a nursing background and experience in clinical settings, case management, and population health. As Health Care Integrator, the individual would lead teams to improve population health, develop metrics to evaluate care delivery, and integrate care across the health continuum through collaboration, education, and data analysis. Key responsibilities include assessing community health needs, coordinating prevention services, identifying high-risk patients, monitoring conditions, evaluating the delivery system, and taking a total community approach to care.
Sheri Cain has over 20 years of experience in nursing, including case management, utilization review, discharge planning, and emergency room nursing. She provides broad nursing care services and develops and implements case management plans in collaboration with healthcare professionals. She promotes integrated services for patients and has strong communication, analytical, and problem-solving skills.
This document is a resume for Brent Salsburey, BSN, RN. It summarizes his experience as a registered nurse over the past 6+ years working in various clinical settings including hospitals, outpatient facilities, and case management. It highlights his strong clinical, assessment and decision making skills in treating a variety of conditions and developing treatment plans. The resume also lists his education as a Bachelor of Science in Nursing from The Ohio State University and certification as a registered nurse in Florida.
- Bridgette Doyle-Handy is seeking a position that utilizes her 1.5 years of emergency medicine experience and 7.5 years of medical/surgical nursing experience.
- She has experience as a charge nurse managing patient volume, documentation, and staff.
- Her resume details over 15 years of nursing experience in hospitals and rehabilitation centers along with various certifications.
This document discusses strategies for engaging healthcare providers in disease management programs when they are also participants, or "members", of those programs. It notes some challenges like maintaining boundaries and roles when providers interact with colleagues. Some effective strategies identified include acknowledging the provider-member's background, allowing input on care plans, using evidence-based guidelines, and having clinical representatives conduct informational sessions for provider-members. Peer support from other provider-members is also suggested. Training and clear communication are important to properly manage these dual provider-member relationships.
This document discusses a model for coordinating care for patients traveling long distances to an academic medical center. It proposes assigning each patient a "temporary medical home" based on their condition to coordinate all aspects of care during their episode of care. This includes assigning a dedicated nurse to coordinate appointments, financial clearance, and navigation through intake, treatment, discharge and follow up. The goals are to improve patient and provider experience, increase patient volumes and revenue, and support the institution's research mission.
Avery Evans has over 10 years of experience in medical and customer services roles. She has a Bachelor's degree in Psychology and is proficient in Microsoft Office, medical software programs, and operating systems. Her experience includes roles as a Patient Services Coordinator at MD Anderson Cancer Center, Lead Trustee for a church, Research Data Coordinator at MD Anderson, and Health Information Management Clerk. She has strong communication, organizational, and problem-solving skills and experience in scheduling, data entry, maintaining confidential patient information, and ensuring quality customer service.
Safety is Personal: Partnering with Patients and Families for the Safest CareEngagingPatients
The work of NPSF"s Lucian Leape Institute's Roundtable on Consumer Engagement, "Safety Is Personal: Partnering with Patients and Families for the Safest Care" is a call to action for health leaders, clinicians, and policy makers to take the necessary steps to ensure patient and family engagement at all levels of health care.The report identifies specific action items for health leaders, clinicians, and policy makers to pursue in making patient and family engagement a core value in the provision of health. care.
This document discusses strategies for home health care agencies to minimize risks from audits. It outlines the various entities that conduct audits, including RACs, MACs, and ZPICs. Key areas that auditors focus on include medical necessity, coding accuracy, documentation quality, and compliance with Medicare policies. The document provides guidance on ensuring documentation clearly supports the patient's homebound status, medical necessity of skilled services, and demonstrates progress towards goals. It emphasizes having objective data to justify findings and treatment plans.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
The document describes the development of a transitional care program called C-TraIn for uninsured and Medicaid patients at Oregon Health & Science University. Key steps included engaging institutional leaders, performing a needs assessment of 116 inpatients, and convening stakeholder work groups. The needs assessment found that many patients lacked access to primary care and faced barriers to medication access. This informed the design of C-TraIn, which includes elements such as a transitional care nurse, pharmacy consultations, 30 days of medications for uninsured patients, and linkages to community medical homes. An economic analysis estimated potential cost savings from reducing readmissions, which helped gain institutional support and funding to implement and study the program.
The document discusses the debate around granting independent diagnostic and prescriptive authority to advanced practice registered nurses (APRNs) in Texas. It argues that while this may help address physician shortages in the short term, the risks outweigh the rewards for several reasons. Expanding APRN scope of practice could fracture Texas' transition to a more coordinated, team-based healthcare model and decrease integration of care. There is also little evidence that APRNs would be more likely than other providers to practice in underserved areas. Additionally, easing educational standards could discourage students from pursuing medical education and undermine primary care workforce development over the long run. The document provides context on nursing roles and compares nurse practitioner and physician education and training requirements
An aging population combined with the decline in the number of primary care providers places unique demands on the provision of health care. Adult-gerontology nurse practitioners provide primary care to adults and the elderly, serve in administrative roles in health care organizations, and evaluate and implement health care policy and programs.
Topics:
What’s the difference between the adult-gerontology nurse practitioner and the family nurse practitioner role?
What should I consider when choosing my nurse practitioner career path?
Focus on the adult-gerontology nurse practitioner specialization
Master’s level vs. doctoral level nursing degrees: Which is right for me?
What is a "super specialization?"
Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.
Natalya Csatari has over 15 years of experience as a registered nurse. She has worked as a care manager for Wellcare Health Plan and United Health Care, where she coordinated care for members, assessed needs, and developed and implemented care plans. She also served as Director of Nursing at Always Care Adult Medical Day Care Center, overseeing nursing services and education. Csatari aims to obtain a position that allows her to utilize her clinical expertise and experience in care coordination and management.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Angela Moss has over 20 years of experience in clinical documentation improvement, case management, coding, and revenue cycle management. She currently works as a Clinical Documentation Improvement Specialist at Barnes Jewish Hospital, where she leads a team of 29 specialists and has helped improve the hospital's mortality index and value-based purchasing scores. She also works as an independent consultant, advising healthcare facilities on ICD-10 readiness and CDI program development.
This document contains a resume for Robin Dale Biron. It lists work experience including positions as an MDS Coordinator at a nursing center, medical director for an exceptional family member program, and registered nurse for the U.S. Army during deployments to Iraq and Germany. Education includes a Master's degree and Bachelor's degree in Nursing. References and affiliations are also provided.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
Improving Patients’ Health Acute Care FinalmHealth2015
mHealth strategies have the potential to improve patient health and outcomes before, during, and after emergency department visits. By facilitating patient triage and decision making before visits, improving communication during visits, and enhancing health literacy and behavior change support after visits, mHealth can help emergency departments improve throughput and post-discharge outcomes. This can increase revenue, avoid penalties, and improve patient satisfaction. Two case studies show that text messaging improved satisfaction scores and appointment adherence for discharged patients from emergency departments.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
Managed care systems like HMOs and PPOs aim to control healthcare costs by establishing networks of providers and using utilization management. They may use capitated reimbursement instead of fee-for-service. Case management also aims to improve quality of care and reduce costs through coordinated care plans. It involves assessing needs, planning care, implementing and coordinating the plan, and monitoring outcomes. Case managers are certified through examinations in case management, disability management, or advanced care coordination. While similar, case management addresses individual needs while disease management focuses on populations with chronic illnesses.
Coordination of Care A Multidisciplinary Approach (Dr Francis Ali-Osman)honorhealth
This document describes a multidisciplinary approach to coordinating patient care. The G60 team coordinates care and includes an attending physician, nurse practitioner, hospitalist, consulting physicians, nurses, pharmacists, therapists, case managers and others. The team meets regularly to discuss patients and ensure all needs are addressed. A multidisciplinary approach can improve outcomes, lower costs, and increase patient satisfaction.
PFCC INFOGRAPHIC: Six Steps to Patient EngagementEngagingPatients
The challenges of creating patient and family-centered care seem daunting. However, the PFCC Innovation Center of UPMC demonstrates it's easier than you think. In this infographic, you see it begins by engaging patients through a simple six step process.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
This document provides a summary of Ruth-Rohini Chawla's experience in the healthcare industry spanning over 18 years. She has held various roles such as operations manager, revenue cycle manager, accounts receivable manager, assistant business manager, and program management specialist. She has extensive expertise in areas such as billing, coding, compliance, and software training. Her most recent role is as a senior financial coordinator at a proton therapy center where she performs financial verification and clearance for patients.
This document describes the role and responsibilities of an Advanced Nurse Practitioner (ANP) working in a general practice setting in the UK. It outlines that ANPs are experienced nurses who can work autonomously to assess, diagnose, treat and review patients. Some key responsibilities include examining and managing patients with both acute and chronic conditions, identifying patients at risk, educating patients, and ensuring high quality care is provided by the nursing team according to patients' needs. The ANP is also responsible for leadership, training, and clinical governance activities to continually improve patient services.
This document discusses strategies for home health care agencies to minimize risks from audits. It outlines the various entities that conduct audits, including RACs, MACs, and ZPICs. Key areas that auditors focus on include medical necessity, coding accuracy, documentation quality, and compliance with Medicare policies. The document provides guidance on ensuring documentation clearly supports the patient's homebound status, medical necessity of skilled services, and demonstrates progress towards goals. It emphasizes having objective data to justify findings and treatment plans.
Weitzman 2013 Relative patient benefits of a hospital-PCMH collaboration with...CHC Connecticut
Anuj K Dalal presents information on a PCORI research grant: Relative patient benefits of a hospital-PCMH collaboration within an ACO to improve care transitions.
The document describes the development of a transitional care program called C-TraIn for uninsured and Medicaid patients at Oregon Health & Science University. Key steps included engaging institutional leaders, performing a needs assessment of 116 inpatients, and convening stakeholder work groups. The needs assessment found that many patients lacked access to primary care and faced barriers to medication access. This informed the design of C-TraIn, which includes elements such as a transitional care nurse, pharmacy consultations, 30 days of medications for uninsured patients, and linkages to community medical homes. An economic analysis estimated potential cost savings from reducing readmissions, which helped gain institutional support and funding to implement and study the program.
The document discusses the debate around granting independent diagnostic and prescriptive authority to advanced practice registered nurses (APRNs) in Texas. It argues that while this may help address physician shortages in the short term, the risks outweigh the rewards for several reasons. Expanding APRN scope of practice could fracture Texas' transition to a more coordinated, team-based healthcare model and decrease integration of care. There is also little evidence that APRNs would be more likely than other providers to practice in underserved areas. Additionally, easing educational standards could discourage students from pursuing medical education and undermine primary care workforce development over the long run. The document provides context on nursing roles and compares nurse practitioner and physician education and training requirements
An aging population combined with the decline in the number of primary care providers places unique demands on the provision of health care. Adult-gerontology nurse practitioners provide primary care to adults and the elderly, serve in administrative roles in health care organizations, and evaluate and implement health care policy and programs.
Topics:
What’s the difference between the adult-gerontology nurse practitioner and the family nurse practitioner role?
What should I consider when choosing my nurse practitioner career path?
Focus on the adult-gerontology nurse practitioner specialization
Master’s level vs. doctoral level nursing degrees: Which is right for me?
What is a "super specialization?"
Over half of patients at a rehabilitation hospital reported wanting greater involvement in their care decisions. To address this, the hospital conducted patient and family shadowing where observers followed patients to experience care from their perspective. This identified themes like explanations during rounds and involvement in discharge plans. A post-intervention survey found a statistically significant improvement in patients feeling involved in care decisions and clinically relevant improvements in understanding doctor explanations and recommending the hospital. Engaging medical leaders and balancing data with reflection time led doctors to change practices without formal rules.
Natalya Csatari has over 15 years of experience as a registered nurse. She has worked as a care manager for Wellcare Health Plan and United Health Care, where she coordinated care for members, assessed needs, and developed and implemented care plans. She also served as Director of Nursing at Always Care Adult Medical Day Care Center, overseeing nursing services and education. Csatari aims to obtain a position that allows her to utilize her clinical expertise and experience in care coordination and management.
PFCC Methodology and Practice: Deliver Ideal Care Experiences and Outcomes…By...EngagingPatients
The document describes the Patient and Family Centered Care (PFCC) methodology used at UPMC, a large integrated health system. The six-step PFCC methodology involves: 1) defining the care experience, 2) forming a guiding council, 3) observing the current state through shadowing, 4) identifying touchpoints through a working group, 5) creating a shared vision for an ideal experience, and 6) implementing improvement projects. The methodology aims to improve outcomes and experiences by engaging patients and families in co-designing care and breaking down silos between care providers. Examples of successful PFCC projects that improved discharge processes and communication through bedside rounding are provided.
Closing the Loop: Strategies to Extend Care in the EDEngagingPatients
This HIMSS15 presentation discusses the challenges faced in hospital emergency departments and offers insights for implementing a process to follow up with discharged ED patients to enhance outcomes and satisfaction,while optimizing utilization and reducing risk.
Angela Moss has over 20 years of experience in clinical documentation improvement, case management, coding, and revenue cycle management. She currently works as a Clinical Documentation Improvement Specialist at Barnes Jewish Hospital, where she leads a team of 29 specialists and has helped improve the hospital's mortality index and value-based purchasing scores. She also works as an independent consultant, advising healthcare facilities on ICD-10 readiness and CDI program development.
This document contains a resume for Robin Dale Biron. It lists work experience including positions as an MDS Coordinator at a nursing center, medical director for an exceptional family member program, and registered nurse for the U.S. Army during deployments to Iraq and Germany. Education includes a Master's degree and Bachelor's degree in Nursing. References and affiliations are also provided.
NCQA_Future Vision for Medicare Value-Based Payments FinalTony Fanelli
This document discusses principles for achieving an optimal future state of quality measurement to support performance-based clinician payment under MACRA. It outlines five principles: 1) Every Medicare enrollee needs a dedicated and well-organized primary care team; 2) Measurement must be specified appropriately for each different unit of accountability; 3) Measurement should support rapid improvement and clinical decision making; 4) A core set of measures will let all stakeholders make comparisons across programs; 5) Quality measure results should be easy for consumers and payers to get and use. The document emphasizes the importance of coordinated, team-based primary care and having measures tailored to different payment and delivery models.
Improving Patients’ Health Acute Care FinalmHealth2015
mHealth strategies have the potential to improve patient health and outcomes before, during, and after emergency department visits. By facilitating patient triage and decision making before visits, improving communication during visits, and enhancing health literacy and behavior change support after visits, mHealth can help emergency departments improve throughput and post-discharge outcomes. This can increase revenue, avoid penalties, and improve patient satisfaction. Two case studies show that text messaging improved satisfaction scores and appointment adherence for discharged patients from emergency departments.
Weitzman 2013: PCORI: Transforming Health CareCHC Connecticut
This document summarizes a presentation given by Joe Selby on the Patient-Centered Outcomes Research Institute (PCORI). It discusses PCORI's mission to fund comparative clinical effectiveness research that is guided by patients and other stakeholders. Key points include: PCORI's focus on research questions of interest to patients and providers; its criteria for funding proposals, including patient-centeredness and engagement; and its plans to significantly increase funding for such research over time. Examples are given of funded pilot projects involving community health centers.
Managed care systems like HMOs and PPOs aim to control healthcare costs by establishing networks of providers and using utilization management. They may use capitated reimbursement instead of fee-for-service. Case management also aims to improve quality of care and reduce costs through coordinated care plans. It involves assessing needs, planning care, implementing and coordinating the plan, and monitoring outcomes. Case managers are certified through examinations in case management, disability management, or advanced care coordination. While similar, case management addresses individual needs while disease management focuses on populations with chronic illnesses.
Coordination of Care A Multidisciplinary Approach (Dr Francis Ali-Osman)honorhealth
This document describes a multidisciplinary approach to coordinating patient care. The G60 team coordinates care and includes an attending physician, nurse practitioner, hospitalist, consulting physicians, nurses, pharmacists, therapists, case managers and others. The team meets regularly to discuss patients and ensure all needs are addressed. A multidisciplinary approach can improve outcomes, lower costs, and increase patient satisfaction.
PFCC INFOGRAPHIC: Six Steps to Patient EngagementEngagingPatients
The challenges of creating patient and family-centered care seem daunting. However, the PFCC Innovation Center of UPMC demonstrates it's easier than you think. In this infographic, you see it begins by engaging patients through a simple six step process.
Creating a standard of care for patient and family engagementChristine Winters
Nationally-recognized governance expert Beth Daley Ullem addresses the state of patient engagement in heathcare and provides a vision for establishing a minimum standard of care for patient engagement programs.
Effective integration of specialty practices into medical neighborhoods is likely to require several important environmental precursors. First, a sound infrastructure
design can connect PCMHs to the spectrum of surrounding
specialty practices. An aligned information architecture
will be vital to adequate patient access, care coordination, and communication. Second, a patient centered
neighborhood will rely on an organizational culture that
supports shared learning and transparency of performance and cost data among participating practices. Third, payment incentives will have to be aligned around shared accountability for outcome and cost. Responsibility
for outcomes and total cost of care will have to rest not only with primary care clinicians, but also with specialists who perform(often expensive) procedures and specialty services.The launch of the NCQA’s PCSP recognition program is a sign of a new phase of delivery system reform
This document provides a summary of Ruth-Rohini Chawla's experience in the healthcare industry spanning over 18 years. She has held various roles such as operations manager, revenue cycle manager, accounts receivable manager, assistant business manager, and program management specialist. She has extensive expertise in areas such as billing, coding, compliance, and software training. Her most recent role is as a senior financial coordinator at a proton therapy center where she performs financial verification and clearance for patients.
This document describes the role and responsibilities of an Advanced Nurse Practitioner (ANP) working in a general practice setting in the UK. It outlines that ANPs are experienced nurses who can work autonomously to assess, diagnose, treat and review patients. Some key responsibilities include examining and managing patients with both acute and chronic conditions, identifying patients at risk, educating patients, and ensuring high quality care is provided by the nursing team according to patients' needs. The ANP is also responsible for leadership, training, and clinical governance activities to continually improve patient services.
Hello, I need assistance with the following I need assistance.docxisaachwrensch
Hello, I need assistance with the following:
I need assistance with the following, would you be able to assist?
The project is the creation of a white paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals var.
Aleta R. Harris is applying for a position as a Nurse Consultant with the Food and Drug Administration. She has over 18 years of experience as a Registered Nurse and 15 years of experience as a Nurse Consultant in case management and education roles. Her experience includes work as a case manager, utilization manager, and team leader with various healthcare organizations. She believes her qualifications in areas like Medicare regulations, case management, and quality improvement would make her well-suited for the Nurse Consultant position.
I need the follwoing assignmentThe project is the creation of a w.docxnatishahaen
I need the follwoing assignment:
The project is the creation of a white paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals vary in size, location, and focus.
Becker’s Hospital Review
has an excellent .
Healthcare ReimbursementI need help on the following assignment C.docxCristieHolcomb793
Healthcare Reimbursement
I need help on the following assignment: Create a white paper. I have coompleted the first part and can provide it to you for help on the second part of the paper.
Much of what happens in healthcare is about understanding the expectations of the many departments and personnel within the organization. Reimbursement drives the financial operations of healthcare organizations; each department affects the reimbursement process regarding timelines and the amount of money put into and taken out of the system. However, if departments do not follow the guidelines put into place or do not capture the necessary information, it can be detrimental to the reimbursement system.
An important role for patient financial services (PFS) personnel is to monitor the reimbursement process, analyze the reimbursement process, and suggest changes to help maximize the reimbursement. One way to make this process more efficient is by ensuring that the various departments and personnel are exposed to the necessary knowledge.
For your final project, you will assume the role of a supervisor within a PFS department and develop a white paper in which the necessary healthcare reimbursement knowledge is outlined.
The project is divided into three milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules One, Three, and Five.
In this assignment, you will demonstrate your mastery of the following course outcomes:
†
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle
†
Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements
†
Analyze organizational strategies for negotiating healthcare contracts with managed care organizations
†
Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations
†
Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on
pay for performance incentives
Prompt
You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an i.
In this assignment, you will demonstrate your mastery of the followi.docxwiddowsonerica
In this assignment, you will demonstrate your mastery of the following course outcomes:
Analyze the impacts of various healthcare departments and their interrelationships on the revenue cycle Compare third-party payer policies through analysis of reimbursement guidelines for achieving timely and maximum reimbursements Analyze organizational strategies for negotiating healthcare contracts with managed care organizations Critique legal and ethical standards and policies in healthcare coding and billing for ensuring compliance with rules and regulations Evaluate the use of reimbursement data for its purpose in case and utilization management and healthcare quality improvement as well as its impact on pay for performance incentives
Prompt You are now a supervisor within the patient financial services (PFS) department of a healthcare system. It has been assigned to you to write a white paper to educate other department managers about reimbursement. This includes how each specific department impacts reimbursement for services, which in turn impacts the healthcare organization as a whole. The healthcare system may include hospitals, clinics, long-term care facilities, and more. For now, your boss has asked you to develop a draft of this paper for the hospital personnel only; in the future, there may be the potential to expand this for other facilities.
In order to complete the white paper, you will need to choose a hospital. You can choose one that you are familiar with or create an imaginary one. Hospitals vary in size, location, and focus. Becker’s Hospital Review has an excellent list of things to know about the hospital industry. Once you have determined the hospital, you will need to think about the way a patient visit works at the hospital you chose so you can review the processes and departments involved. There are several ways to accomplish this. Choose one of the following:
If you have been a patient in a hospital or if you know someone who has, you can use that experience as the basis for your responses. Conduct research through articles or get information from professional organizations.
Below is an example of how to begin framing your analysis.
A patient comes in through the emergency department. In this case, the patient would be triaged and seen in the emergency department. Think about what happens in an emergency area. The patient could be asked to change into a hospital gown (think about the costs of the gown and other supplies provided). If the patient is displaying signs of vomiting, plastic bags will be provided and possibly antinausea medication. Lab work and possibly x-rays would be done. The patient could be sent to surgery, sent home, or admitted as an inpatient. If he or she is admitted as an inpatient, meals will be provided and more tests will be ordered by the physician—again, more costs and charges for the patient bill. Throughout the course, you will be gathering additional information th.
Resume: Xena Gohan
Resume: Xena Gohan
Xena Gohan 123 Main Street, San Francisco, CA 94122 Phone C: (000)000 0000 Phone H: (000) 000 0000 E-mail: [email protected]
Objectives
Seeking a position as a supervisor in respiratory care in a health institution that can utilize my experience in hospital and home respiratory care management and assist the management team to achieve departmental goals
Education
Master in Public Health currently enrolled
Grant Canyon University
Bachelors in Healthcare Administration and Patient Care
Grand Canyon University Feb 2018
Associate of Science in Respiratory Care May 2004
Nassau Community College, Garden City, NJ 11580
Certifications
Basic Life Support 2004 - Present
Awards
Clinical excellence awards and best preceptor awards 2015, 2016
Community Service
Provide education at New Hyde Park public school system on symptoms and management of acute allergic reactions and asthma attacks, with the demonstration of the proper use of
inhalers to students
Experience
Respiratory Care Manager
Northwell Health, New Hyde Park, NJ110740 November 2016- Present
· Supervise, organize and coordinate the clinical and technical aspects of all Respiratory services to insure the delivery of quality therapeutic services.
· To assure that all policies and procedures are followed according to the department policy and procedure manuals.
· Provide clinical and technical supervision and expertise to staff members on the assigned shift. Regularly reviews all staff performance via daily auditing and or daily rounding to assure adherence to department policies and procedures.
· Counsels staff members and administers and documents appropriate disciplinary action or coaching opportunities when policy and procedures are not followed.
· Completes employee evaluations annually according to the hospital performance management process.
Registered Respiratory Therapist February 2004 –Present
Long Island Jewish Hospital, New Hyde Park, NJ 11050
· Provide respiratory care assessment and treatment to adult, pediatric and neonatal patients
· Work with the primary health care providers and participate in multidisciplinary rounds in critical care units
· Assist nurses and EMS in the transport of patients with respiratory diseases
· Determine the course of treatment including mode and duration of therapy and infection control precautions needed for the safety of patient, health care providers
and visitors
· Monitor patient's physiological responses to the treatment through vital signs, arterial blood gases, blood chemistry and recommend treatment chan ...
Empirical research estimates that medical errors cost an estimated 19.5 billion dollars in healthcare costs and nearly 400,000 patients die annually due to these errors. 1As a result, the federal government has adopted a new regulation that creates incentives for hospitals and their sta to improve the quality of patient care. 2This new regulation ties patient care to Medicare reimbursements. In other words, how well a hospital provides patient care determines whether that hospital incurs a penalty or a bonus in the form of a percent reduction or increase of Medicare reimbursement rates.
The document discusses the importance of evaluating mental health professionals through regular professional evaluations. These evaluations help identify areas for improvement, discuss difficult practices, and establish support to prevent burnout. Clinical supervisors are responsible for assessing supervisees to identify issues that need attention in order to further develop their quality of care.
Write a 3 page evidence-based health care delivery plan for one .docxowenhall46084
Write a 3 page evidence-based health care delivery plan for one component of a heart failure clinic.
Nursing within an organization is a critical component of health care delivery and is an essential ingredient in patient outcomes (Kelly & Tazbir, 2014). The concern for quality care that flows from evidence-based practice generates a desired outcome. Without these factors, a nurse cannot be an effective leader. It is important to lead not only from this position but from knowledge and expertise.
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:
Competency 2: Explain the accountability of the nurse leader for decisions that affect health care delivery and patient outcomes.
Describe accountability tools and procedures used to measure effectiveness.
Competency 3: Apply management strategies and best practices for health care finance, human resources, and materials allocation decisions to improve health care delivery and patient outcomes.
Develop an evidence-based plan for health care delivery.
Competency 4: Apply professional standards of moral, ethical, and legal conduct in professional practice.
Apply professional and legal standards in support of a care plan.
Competency 5: Communicate in manner that is consistent with the expectations of a nursing professional.
Write content clearly and logically, with correct use of grammar, punctuation, mechanics, and current APA style.
In an effort to improve the patients' health literacy concerning heart failure, it is important that the clinic staff and the hospital staff present a consistent, evidence-based message on self-care to these patients and their families in order to decrease acute exacerbation and re-admissions. Review current evidence for clinical practice guides or protocols when developing your patient teaching plans and materials. Consider the following:
What does the patient know about the disease process as a baseline?
What does the patient need to do understand as far as the best self-care processes?
Can the patient identify proper medication compliance?
Is there a financial issue that affects compliance?
Who buys and prepares the food in the home?
Can the patient verbalize when to seek medical assistance?
Instructions
Deliverable:
Develop an evidence-based plan for health care delivery.
Scenario:
The hospital where you work has an issue with increased readmissions within 30 days of discharge. After examining the core measures, it was found that heart failure was the most common core measure disease process experiencing the highest rate of readmissions. The leadership team has given your team the charge of developing a nurse-run outpatient heart failure clinic. The purpose of this clinic is to ensure that discharge education is presented to the patient in an orderly, consistent manner and complies with evidence-based practice protocol.
The document discusses the role of DNP-prepared healthcare leaders and their positive impact on healthcare systems through improved patient outcomes, innovation, and influence. It also discusses strategies for implementing evidence-based guidelines in clinical practice, including identifying issues, searching for evidence, applying evidence, and evaluating impacts. Barriers to implementation include lack of training, unclear roles, and lack of buy-in from stakeholders. Overcoming barriers requires effective communication, collaboration, and addressing resistance to change by emphasizing benefits to patients and staff. Additional resources like meeting spaces and educational materials may be needed.
Angelia Hart has over 15 years of experience in healthcare management roles including credentialing, case management, medical staff management, and provider network management. She holds an LPN license and BS in Health Services Management. Her resume highlights her experience as the Credentialing Manager at JSA Healthcare where she oversees the credentialing department and works to achieve delegated credentialing status. Prior to that, she was the In Patient Care Manager at JSA Healthcare where she coordinated patient care and discharge planning.
Case management involves eight key activities: assessment, planning, implementation, coordination, monitoring, evaluation, outcomes measurement, and general activities. It is a collaborative process that helps ensure a client's needs are met in a quality, cost-effective manner. Case managers at Medina Hospital focus on discharge planning, utilization review, and tracking avoidable days to facilitate positive patient outcomes and reduce financial risk for the facility.
Here are some potential problems with the client's goals and how the care manager could offer guidance:
- The goals are too ambitious and unrealistic given the client's history and health conditions. Trying to make such drastic changes quickly could lead to failure and decreased motivation.
- The care manager could suggest starting with small, gradual changes that are more sustainable, like taking a 30-minute walk 3 times a week and cutting back on added sugars rather than eliminating them completely.
- Setting incremental, achievable goals will help the client experience success and build confidence in their ability to improve their health long-term. The care manager should emphasize progress over perfection.
- The care manager could also explore what barriers might get in the way of
Patient Resource: Medicare Observation Versus Admit DaysTerri Embry RN BS
This resource provides information a patient, their advocate or a health care professional can use to learn about this topic. Hyperlinks are embedded to allow for self guided research and is encouraged.
This document discusses strategies for engaging healthcare providers in disease management programs when they are also participants, or "members", of those programs. It notes some challenges like maintaining boundaries and roles when providers interact with colleagues. Some effective strategies identified include acknowledging the provider-member's background, allowing input on care plans, using evidence-based guidelines, and having clinical representatives conduct informational sessions for provider-members. Peer support from other provider-members is also suggested. Training and clear communication are important to properly manage these dual provider-member relationships.
PHM Tools and Strategies to Support Care Coordination infomc
This document discusses population health management tools and strategies to support care coordination. It describes how InfoMC's InSpotlight tools can help identify at-risk individuals in a population for improved health outcomes through targeted care coordination. The tools aggregate data from multiple sources to stratify populations and identify factors contributing to poor health. This supports effective care plans and workflows to better integrate physical and behavioral healthcare across providers.
The document discusses the referral system within the healthcare infrastructure in India. It defines referral as transferring a patient's care to a higher level facility that has more resources and specialized services. The referral system works vertically from primary to secondary to tertiary care centers. The goals of the referral system are to provide comprehensive care at each level and access to specialized services. It emphasizes coordination between facilities, timely referrals, and sharing of responsibility in patient care.
1. ARMY POSITION DESCRIPTION
PD#: DNMC341344 Sequence#: VARIES Replaces PD#:
NURSE (CLINICAL/CASE MGMT)
GS-0610-12
POSITION LOCATION:
Servicing CPAC: FORT BRAGG, NC Agency: VARIES
Installation: VARIES Army Command: VARIES
Region: SOUTH CENTRAL Command Code: VARIES
POSITION CLASSIFICATION STANDARDS USED IN CLASSIFYING/GRADING
POSITION:
Citation 1: OPM PCS NURSE SERIES, GS-610, JUN 77
Supervisory Certification: I certify that this is an accurate statement of the major duties
and responsibilities of this position and its organizational relationships, and that the
position is necessary to carry out Government functions for which I am responsible. This
certification is made with the knowledge that this information is to be used for statutory
purposes relating to appointment and payment of public funds, and that false or
misleading statements may constitute violations of such statutes or their implementing
regulations.
Supervisor Name: Reviewed Date:
Classification Review: This position has been classified/graded as required by Title 5,
U.S. Code in conformance with standard published by the U.S. Office of Personnel
Management or if no published standards apply directly, consistently with the most
applicable published standards.
Reviewed By: MEDCOM STANDARDIZED PD Reviewed Date: 04/06/2010
POSITION
INFORMATION:
Cyber Workforce:
l Cert Type/Level
Required 1: VARIES
CONDITION OF
EMPLOYMENT:
Drug Test Required:
VARIES
Financial Management
POSITION
ASSIGNMENT:
Competitive Area:
VARIES
Competitive Level:
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2. l Cert Type/Level
Required 2: VARIES
l Cert Type/Level
Required 3: VARIES
FLSA: EXEMPT
FLSA Worksheet: EXEMPT
FLSA Appeal: NO
Bus Code: VARIES
DCIPS PD: NO
l Mission Category:
l Work Category:
l Work Level:
Acquisition Position: NO
l CAP:
l Career Category:
l Career Level:
Functional Code: 81
Interdisciplinary: NO
Supervisor Status:
VARIES
PD Status: VERIFIED
DCA Override: NO
Certification: VARIES
Position Designation:
VARIES
Position Sensitivity:
VARIES
Security Access: VARIES
Emergency Essential:
Requires Access to
Firearms: VARIES
Personnel Reliability
Position: VARIES
Information Assurance:
N
Influenza Vaccination:
YES
Financial Disclosure: NO
Enterprise Position:
VARIES
VARIES
Career Program: VARIES
Career Ladder PD: NO
Target Grade/FPL: 12
Career Pos 1:
Career Pos 2:
Career Pos 3:
Career Pos 4:
Career Pos 5:
Career Pos 6:
POSITION DUTIES:
THIS IS A STANDARDIZED MEDCOM POSITION DESCRIPTION. DO NOT MAKE ANY
CHANGES TO THIS PD WITHOUT MEDCOM CHRD APPROVAL.
Serves as a Nurse Case Manager in order to provide professional case management and
health planning services. The incumbent of this position serves as a member of a
multidisciplinary team to provide assessment, planning, implementation, coordination,
evaluation, and monitoring of patients for health options and services. The incumbent
helps develop, analyze, integrate, monitor, and manage healthcare delivery systems
Through communication and use of resources to promote quality and cost-effective
outcomes across the continuum.
1. Provides advanced practice clinical nursing, administrative and organizational skills in
managing the continuity of care for the beneficiary populations. Conducts a
comprehensive assessment of beneficiary’s health needs in order to develop a plan of
care. Plans with the patient, the Family, the primary care physician/provider, other
healthcare providers, the payer, and the community, to maximize healthcare response
and quality, cost effective outcomes. Facilitates communication and coordination between
members of the healthcare team. Educates both the patient and members of the
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3. healthcare delivery team about case management, healthcare and treatment options,
community resources, insurance benefits, psychosocial concerns, etc., so that informed
decisions can be made. Engages in problem-solving, exploring options to care when
available and alternative plans when necessary to achieve desired outcomes. Encourages
appropriate use of healthcare services and strives to improve quality of care and maintain
cost effectiveness. Empowers patients and serves as an advocate for both patients and
the healthcare team to facilitate positive outcomes.
60%
2. Provides oversight and input to nursing practice matters. Incumbent participates in the
identification of processes, systems, and practice metrics; and in determining measures of
care outcomes for the population served.
a. Attends multidisciplinary meetings, identifies potential case management clients
through health planning assessments, review of the multiple databases and points of
contacts available for the specified population. This screening process may include, but is
not limited to the Emergency Department log, physicians, nurses, Managed Care and the
clients themselves.
b. Screens all potential case management clients within established timeframe after
identification for appropriateness/benefit of case management services to client and/or
institution.
c. Interviews and counsels potential case management clients within established
timeframe as to services needed to optimize current health/psychosocial status and
benefits of case management services. Once the client accepts case management, the
approved metrics will be entered into a prescribed database for tracking purposes along
with clinical progress notes on the client's status.
d. Introduces innovative nursing techniques, practices, and approaches in collaboration
with health care providers to identify, assess, educate, plan, and coordinate care through
programs designed to provide efficient, comprehensive and cost effective service for case
managed patients.
e. Coordinates with patient-focused multidisciplinary teams of clinicians to develop time
line protocols/clinical guidelines which delineate the expected process of care delivery for
selected case managed patients and provide high quality affordable health care to its
beneficiaries. Monitors exceptions, deviations, and differences from the established
protocols to identify and report problems. Variances are analyzed and reported through a
continuous process improvement channel to seek solutions and improve delivery of care.
Accountable for coordination of care for select groups of complex patients to ensure
desirable patient outcomes are achieved. Consults and coordinates with other multi-
disciplinary care professionals, agencies, organizations, and other ancillary support
systems to assist patients to optimize their level of function and self care.
f. Conducts extensive evaluation of case management patients to establish in detail and
specificity the nature of their continuity of care needs as well as causal and contributing
conditions and circumstances. Conducts comprehensive clinical interviews with the patient
and other family members, as warranted, collects data from all involved health care
agencies, medical providers and resource programs. Participates in a multidisciplinary
team to develop a treatment plan to deal with all identified conditions and problems.
Identifies psychosocial aspects of anticipated care needs to identify potential barriers to
optimal health and resource utilization. Identifies methods for minimizing such barriers
and assists the patient and the family in developing and implementing appropriate care
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4. plans, and accessing agencies and care providers.
g. Interfaces with local, state and federal agencies responsible for financing alternative
programs such as Home Health Care which DoD beneficiaries may be entitled to receive.
Obtains regulations, policy manuals and handouts from these agencies and develops
procedural guidelines to provide access to these programs in concert with TRICARE or
other governmental or private insurance coverage.
h. Identifies problems with health care access and utilization in both the military and
civilian sectors and recommends alternatives to overcome these difficulties. Problem areas
addressed may include admissions, outpatient visits, bill charges, acquisition of
equipment and services, patient complaints and inquiries as well as population health, and
quality improvement issues.
i. Assists in identifying strategies designed to improve patient access, improve adherence
to population health metrics, and reduce administrative burdens for DoD beneficiaries and
improve the cost effectiveness for the civilian/military health care delivery system.
Obtains feedback from the Fiscal Intermediary, TRICARE and the Health Care Finders to
identify problem areas. Proposes regulatory and administrative changes to resolve
identified problems.
j. Provides guidance on establishing appointment protocols to match patients' needs with
available resources in a timely manner. Coordinates with the medical staff to determine
medical appropriateness of selected appointment alternatives in relation to timeliness of
available care.
k. Develops guidelines for interfacing with the Health Care Finder Service with the
equivalent functions of the civilian health care delivery system supporting TRICARE.
Ensures guidelines are in compliance with program goals and that the medical staff of
both the military and civilian facilities is informed of these guidelines.
l. Acts as Nurse Consultant through holistic approach to address health care needs in
collaboration with all health team members to include the patient and the patient's family
as warranted. Provides education and clinical assistance through advanced nursing
knowledge, skills and techniques to nursing personnel, medical students,
interns/residents, staff physicians and administrators. Duties include formal and informal
consultation, briefings and informal/formal educational offerings. Provides first level
review of DME and Home Health consults and coordination of civilian care transfers.
Represents the Medical Management Service on or before a variety of committees,
boards, agencies, and concerned groups. Represents and serves as an advocate for the
program, patients, and their families in obtaining services and support for their special
needs.
m. Directs and manages a case managed patient population.
30%
3. Supervisory duties: Assign work to subordinates based on priorities, difficulty of
assignments, and the capabilities of employees. Provide technical oversight. Develop
performance plans and rate employees. Interview candidates for subordinate positions;
recommend hiring, promotion, or reassignments. Take disciplinary measures, such as
warnings and reprimands. Identify developmental and training needs of employees;
provide and/or arrange for needed development and training.
10%
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5. PERFORMS OTHER DUTIES AS ASSIGNED.
CONDITIONS OF EMPLOYMENT:
THIS POSITION IS COVERED BY THE CIVILIAN DRUG ABUSE TESTING PROGRAM.
INCUMBENT IS REQUIRED TO SIGN A DA FORM 5019-R, AND/OR DA FORM 7412
"CONDITION OF EMPLOYMENT FOR CERTAIN CIVILIAN POSITIONS IDENTIFIED AS
CRITICAL UNDER THE DRUG ABUSE TESTING PROGRAM."
THIS IS AN INCLEMENT WEATHER ESSENTIAL POSITION: INCUMBENT IS EXPECTED TO
MAKE EVERY ATTEMPT TO REPORT FOR DUTY ON TIME AND/OR REMAIN ON DUTY
DURING SEVERE WEATHER CONDITIONS.
THIS JOB MAY ON OCCASION ENTAIL EVENING AND WEEKEND DUTY. THIS JOB MAY
ENTAIL OCCASIONAL VISITS TO PATIENT'S HOME OR OTHER TREATMENT FACILITIES AS
PART OF CASE MANAGEMENT FUNCTION.
CHILD CARE BACKGROUND CHECK REQUIRED FOR THIS POSITION.
FACTOR 1 KNOWLEDGE REQUIRED BY THE POSITION FL 1-7 1250 PTS
Professional knowledge of a wide range of nursing concepts and principles IAW Standards
of Nursing Practice, as well as extended experience with case management practices and
procedures to analyze the full scope of problems associated with providing appropriate,
cost effective care to DoD beneficiaries. This clinical knowledge is applied to solve both
administrative and professional health care problems relating to all case managed health
care.
Professional knowledge of nursing theory, hospital administrative operations and
procedures and how they interact with clinical and administrative information systems,
which includes matters pertaining to budget, personnel, credentialing, and an
understanding of the configuration and management of hospital data and information of
patient care, demographics, workload, and costs.
Knowledge of principles of healthcare provided to psychiatric, disease, and injury
casualties during military operations across all healthcare functional areas in order to
develop comprehensive data collection strategies.
Professional knowledge and ability to identify performance metrics and measure
population health care outcomes.
Professional knowledge in the appropriate referral of cases to other clinicians and services
when indicated.
Ability to effectively communicate orally and in writing with health providers at all levels
and negotiates with outside providers/vendors for services and products.
Knowledge of the military and regional health care delivery systems, including the specific
characteristics/objectives/requirements of each system for use in developing nursing and
clinical workload and performance reports.
Knowledge, skill and ability to provide professional assistance to health care finders in
identifying patients' needs for referral to appropriate health care providers.
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6. Knowledge, skill and ability to use basic office automation and information management
equipment and programs, (i.e., word processing, database, email, etc.) and to input,
track and evaluate data for outcome management purposes.
FACTOR 2 SUPERVISORY CONTROLS FL 2-4 450 PTS
Receives general supervision. Supervisor provides general guidance and defines overall
objective and policies. Incumbent plans and carries out work independently in accordance
with general guidance, policies and previous experience. Coordinates with agency and
community officials and resources. Develops plans for study and carries through to
completion with recommended action resulting from study. Work review is in terms of
effectiveness in meeting program objectives, initiatives employed and soundness of
judgment exercised.
FACTOR 3 GUIDELINES FL 3-4 450 PTS
General guidelines and procedures exist but are not completely applicable to the case
managed client and every situation likely to be encountered. Based on patient population
targeted, incumbent develops, implements, evaluates and modifies multidisciplinary
patient care policies and procedures in conjunction with the Care Management Service
and the specialized Health Care Teams involved in the client's care. Incumbent
contributes to the modification of existing guidelines or policies through participation in
studies which often result in changes in treatment procedures, policies and services. In
the absence of existing guidelines, the incumbent must exercise judgment, knowledge
and ingenuity in establishing protocol, organization and activities pursuant to solving the
problem at hand. The employee must exercise initiative and resourcefulness in carrying
out assigned clinical, administrative and supervisory responsibilities.
FACTOR 4 COMPLEXITY FL 4-5 325 PTS
The work includes varied duties requiring many different and unrelated processes and
methods applied to a broad range of substantial depth of analysis and independently
performing difficult and complex reviews and analysis of case managed situations to
assess and evaluate specific provisions of health care, along with other criteria. Decisions
regarding what needs to be done include major areas of uncertainty in approach,
methodology, or interpretation and evaluation processes resulting from such elements as
continuing changes in technological developments in the nursing or medical field.
Independently performs difficult and complex reviews and analysis of case managed
situations to assess and evaluate specific provisions of health care. Requires extensive
experience in dealing with and resolving problems relating to direct and indirect
healthcare issues requiring consideration of both. Exercises considerable resourcefulness
and judgment to implement modifications to existing procedures or to develop new and
innovative procedures to improve services and resource utilization.
FACTOR 5 SCOPE AND EFFECT FL 5-4 225 PTS
The purpose of the work is to provide a medically-oriented professional evaluation of case
management services, medical and nursing support as well as administrative services and
products provided to assess the efficiency, effectiveness and economy of those services
and products and to identify, recommend and implement improvements as deemed
appropriate. Also, provides direction to health care providers and assistance to patients in
obtaining health care benefits. The work significantly impacts the overall provision of
health care treatment and services in the catchment area.
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7. FACTOR 6 PERSONAL CONTACTS FL 6-3 60 PTS
Contacts include DA and DoD personnel, utilization management officials, community
assistance agencies, contract services and product delivery agency. Contacts are with
individuals or groups from outside the employing agency to include high level officials
such as DA and DoD personnel in a moderately unstructured setting. Personal contacts
are with selected patients and their families, healthcare providers and treatment planners
from within and outside the agency.
FACTOR 7 PURPOSE OF CONTACTS FL 7-3 120 PTS
Contacts are to coordinate, plan and facilitate patient evaluation and treatment and
conduct training on the implementation of patient care maps, discuss treatment policies;
discharge planning and possibilities for procedural changes. Through the training program
execution, the incumbent will be responsible for training and guidance to all levels of
health care providers. Some contacts are for negotiating agreements and influencing
modifications to existing procedures, to assess patient needs, and to advise on or
coordinate internal and external actions.
FACTOR 8 PHYSICAL DEMANDS FL 8-1 5 PTS
Some walking, standing, bending, and carrying light items and driving an automobile to
conduct external business. The work is stress related and requires emotional stability and
maturity in the face of crisis intervention and/or prolonged anxiety.
FACTOR 9 WORK ENVIRONMENT FL 9-1 5 PTS
Work involves normal everyday risks or discomforts typical of offices, meeting rooms,
etc., which am adequately heated, lighted and ventilated. While some biological and/or
radiological hazards may be present, such areas are clearly marked so that protective
measures can be taken.
TOTAL POINTS: 2890
POINT RANGE: 2755-3150
GS-12 PHYSICAL EXAM MAY BE REQUIRED.
This position has a mandatory seasonal influenza vaccination requirement and is
therefore subject to annual seasonal influenza vaccinations. Applicants tentatively
selected for appointment to this position will be required to sign a statement
(Condition of Employment) consenting to seasonal influenza vaccinations.
ALL EMPLOYESS ASSIGNED TO A MTF ARE REQUIRED TO BE SCREENED FOR
APPLICABLE IMMUNIZATIONS REGARDLESS OF SERIES, BASED ON
OCCUPATIONAL RISK, AND ARE SUBJECT TO MISSING/REQUIRED
IMMUNIZATIONS IAW AR 40-562, CHAPTERS 3 & 4.
PHYSICAL EXAM MAY BE REQUIRED
Fair Labor Standards Act (FLSA) Determination = (EXEMPT)
1. Availability Pay Exemption - (e.g., Criminal Investigators, U.S.
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8. Customs and Border Protection pilots who are also Law Enforcement
Officers).
2. Foreign Exemption - (Note: Puerto Rico and certain other locations
do not qualify for this exemption – See 5 CFR 551.104 for a list of
Nonexempt areas.)
3. Executive Exemption:
a. Exercises appropriate management responsibility (primary duty)
over a recognized organizational unit with a continuing function,
AND
b. Customarily and regularly directs 2 or more employees, AND
c. Has the authority to make or recommend hiring, firing, or other
status-change decisions, when such recommendations have
particular weight.
Note: Shared supervision or “matrix management” responsibility for a
project team does not meet the above criteria. Limited “assistant
manager” functions or “acting in the absence” of the manager does not
meet the above criteria.
4. Professional Exemption:
a. Professional work (primary duty)
b. Learned Professional, (See 5 CFR, 551.208 ) (Registered Nurses,
Dental Hygienists, Physician’s Assistants, Medical Technologists,
Teachers, Attorneys, Physicians, Dentists, Podiatrists, Optometrists,
Engineers, Architects, and Accountants at the independent level as
just some of the typical examples of exempt professionals). Or
c. Creative Professional, (See 5 CFR, 551.209 ) (The primary duty
requires invention and originality in a recognized artistic field
(music, writing, etc.) and does not typically include newspapers or
other media or work subject to control by the organization are just
some examples of Creative Professionals). Or
d. Computer Employee, (See 5 CFR, 551.210 ) ( must meet salary
test and perform such duties as system analysis, program/system
design, or program/system testing, documentation, and
modification). Computer manufacture or repair is excluded (non-
exempt work).
5. Administrative Exemption:
a. Primary duty consistent with 5 CFR 551 (e.g.; non-manual work
directly related to the management or general business operations
of the employer or its customers), AND job duties require exercise
of discretion & independent judgment.
FLSA Conclusion:
Exempt
Non Exempt
FLSA Comments/Explanations:
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9. Duties 1, 2 and 3 meet the exemption criteria.
CONDITIONS OF EMPLOYMENT & NOTES:
POSITION EVALUATION:
Not Listed
Page 9 of 9Position Description
5/20/2015https://acpol2.army.mil/ako/fasclass/search_fs/search_fs_output.asp?ccpo=DN&jobNum=...