Clinical Program Coordinator Registered Nurse

• Develops and implements patient screening and clinical assessment tools in partnership with physicians, program staff and leadership.
• Develops and implements plan for program quality improvement in collaboration with internal quality departments. Establishes quality indicators for benchmarking patient data to evaluate program success and demonstrate excellence in clinical care and service. Identifies performance improvement issues and makes recommendations for change.
• Evaluates program outcomes; compiles and presents data to leadership on specific indicators to measure the provision of care quality and effectiveness. Ensures reliable research and statistical techniques are used to analyze data to plan and evaluate program success.
• Participates in the planning and implementation of standards of care and standards of service in collaboration with clinical providers from a variety of departments and interdisciplinary teams.
• Coordinates referrals to the program by obtaining insurance information, prior authorization and confirmation of payer source on behalf of the patient. Works closely with payers to estimate benefits, discuss treatment plans, diagnosis, medication information, and other related health information to obtain appropriate referrals and authorization.
• Maintains and facilitates communication based on documentation, staffing processes, and verbal exchange of program team members with patients, referral sources, reimbursement sources, and other involved entities. Maintains direct dealings with lawyers, paralegals, and physicians when handling issues associated with worker’s compensation cases.
• Collaborates with case management and other clinical staff to manage the continuity of care across facilities and multiple providers to ensure smooth transitions between care settings, including obtaining medical records from referral sources. Meets with interdisciplinary staff regularly to review patient cases and treatment plans.
• Acts as liaison between clinical program staff, patients, and other healthcare professionals, assists and provides guidance with patient care planning and patient scheduling. Develops strong relationships with physicians, community organizations/leaders to enhance program recognition and growth. Responds to community education and outreach needs. Works closely with business and market development to coordinate community events.
• Identifies growth opportunities and program development needs, collaborates with program leadership and physicians to develop these areas. Establishes referral mechanisms with new providers to increase patient volumes utilizing research based information, trends, professional promotion ideas, etc.
• Maintains knowledge and expertise in understanding payer mix and funding resources related to interdisciplinary care provided in a program setting in collaboration with the coding and billing departments.

Licensure, Registration, and/or Certification Required:

• Registered Nurse license issued by the state in which the team member practices.

Education Required:

• Bachelor’s Degree in Nursing.

Experience Required:

• Typically requires 5 years of experience in nursing.

Knowledge, Skills & Abilities Required:

• Demonstrated ability to develop collaborative, positive professional relationships with a variety of individuals, i.e., patients, family members, physicians, and staff.
• Excellent interpersonal and communication (oral and written) skills.
• Proficient computer skills; experience with Microsoft Office applications, electronic mail and electronic medical records systems.

Physical Requirements and Working Conditions:

• May be exposed to electrical and chemical hazards as well as blood and body fluids and therefore must wear protective clothing and equipment as needed.
• Position requires travel, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.