Major Responsibilities:

• MRA Home Visits
  • 1)Review medical records to ensure appropriateness and accuracy of International Classification of Diseases, ICD-10 coding in relation to risk adjustable coding. Identifies coding errors and recommends correct coding and terminology usage based on ICD-10-CM in accordance with regulatory agencies and specific guidelines.
  • 2)Performs ongoing data analysis and reporting to identify coding, compliance and reimbursement issues..
  • 3)Provides ongoing training and education to PAN providers on current coding practices, governmental regulations reimbursement issues.
  • 4)Serves as an expert coding resource to the Post Acute Network to provide Medicare compliant revenue enhancement.
  • 5)Maintains a current understanding of regulatory trends and changes in coding policy and reimbursement that affect PAN by monitoring governmental resources, electronically or through publications, to assess regulatory changes and determine organizational impact.
  • 6)Responsible for: Assists in the development of coding educational plans, materials, and resources to educate PAN providers and associates with respect to the overall objectives of PAN MRA Coding.
  • 7)Provide New APN On- Boarding MRA coding education
  • 8)Develops and updates training and education materials as required to maintain the most current coding guidelines.
  • 9)Serves as a coding resource to PAN staff. Provides recommendations on seminars or coding educational resources for staff to enrich skills
  • 10)Develops procedures to assist the PAN division in assigning accurate diagnosis codes and medical necessity information on required documents to support reimbursement.
• Direct Patient Care
  • 1)Utilizes the scientific process and national standards of care as a framework for managing patient care.
  • 2)Independently provides direct patient care through history taking, physical assessment.
  • 3)Maintains a collaborative practice agreement with physicians (s) with written protocols or guidelines for practice that are annually reviewed and updated as necessary. Collaborates with physicians as needed.
  • 4)Establishes a diagnosis by utilizing critical thinking in the diagnostic process, synthesizing and analyzing the collected data and formulating a differential diagnosis based on the history, physical examination and diagnostic tests.
  • 5)Establishes priorities to meet the health and medical needs of the individual, family and community.
  • 6)Documents accurately and legibility in a paper or electronic medical record. Participates in the CI process by documenting on the appropriate flow sheets.
  • 7)Facilitates and implements systems that promote and maintain effective communication and collaboration with physicians, nurses, and other members of the health care team.
  • 8)Acts as resource to nursing staff for complex patients and assists staff in assessing and planning the care of these patients.
  • 9)Formulates treatment plan by including ordering additional tests, selecting and prescribing the appropriate pharmacological and non-pharmacological interventions, developing a patient education plan and appropriate consultation /referral.
  • 10)Develops treatment plan with patient, which may include prescriptive medication, OP therapies, and consultation with other primary care providers and/or education on health promotion/lifestyle changes as needed.
• Interdisciplinary/Collaborative Responsibilities
  • 1)Participates as a team member in the provision of health and medical care, interacting with professional colleagues to provide comprehensive care.
  • 2)Offers expert advise and skill to the treatment team (i.e., physicians, nurses, ancillary staff, etc.), to facilitate in the management of complex patient and family problems.
  • 3)Acts as an advanced practice resource for educational and problem solving purposes.
  • 4)Participates in community health education programs for the purpose of promoting health and wellness in the community.
  • 5)Provides education for patients, families and members of the health care teams.
• Education/Certification
  • 1)Participates in quality assurance review, including systematic review of records and treatment plans on a periodic basis
  • 2)Maintains current knowledge by attending continuing education programs.
  • 3)Maintains current licensure and certification in compliance with current state law. Maintains current DEA.
  • 4)Applies standardized care guidelines in clinical practice
  • 5)Identifies and addresses opportunities to improve clinical practice and delivery of care.
  • 6)Integrates nursing research into clinical practice and disseminates information to staff.
  • 7)Identifies opportunities to improve quality of patient care and follows through with relevant departments, managers, supervisors and staff.
  • 8)Promotes CQI activities to improve quality of care, i.e.: team leader, team facilitator, and team member.
  • 9)Keeps abreast of new diagnostic and treatment approaches along with market changes in order to assist Advocate Medical Group in meeting the challenges of an ever-changing health care market.
• Accountability A Continued...
  • 1)Implements a plan of care that is individualized, consistent with the appropriate plan of care and is based on scientific principles, theoretical knowledge and clinical expertise.
  • 2)Determines the effectiveness of the treatment plan with documentation of patient care outcomes.
  • 3)Reassess and modify the plan as necessary to achieve health and medical goals.
  • 4)Provides health education and utilizes community resource opportunities for the individual and/or family.
  • 5)Facilitates patient participation in health and medical care by providing information needed to make decisions.
  • 6)Serves as a patient advocate, and participates in health policy activities at the local, state, national and international levels.

Licensure:

• Nurse, Advanced Practice (APN) AND Nurse, Registered (RN)

Education/Experience Required:

• * Masters Degree in Nursing. * 1 years clinical experience in family practice (adults and pediatrics) or new graduate with 5 years of clinical experience (adults and pediatrics) * This position will need to recognize needs and behaviors of a variety of age groups of patients and provide age appropriate care.

Knowledge, Skills & Abilities Required:

• * Well developed written skills. * Well developed interpersonal and communication skills. * Performs adequate psychological and physical assessment of patients. -PC literate
• * National certification as a Nurse Practitioner. * Current Illinois APN License * Current Illinois Registered Nurse license.

Physicial Requirements and Working Conditions:

• - Ability to travel to patient's home. Will be required to make several visits per day. - Ability to perform physical tasks such as lifting patients and moving equipment. - Ability to work varying shifts to meet the needs of the center. Early mornings, evenings and weekends required - Able to respond quickly to patient needs and work at a fast pace. - Work under stressful conditions and in difficult situations. - The candidate must be able to perform physical tasks such as lifting patients and moving equipment. - Work environment includes the probability of exposure to adverse, hazardous or unpleasant conditions while caring for the sick.
• If position has direct patient care or direct patient contact the following lifting requirement supersedes any previous lifting requirement effective 06/01/2015. Ability to lift up to 35 pounds without assistance. For patient lifts of over 35 pounds, or when patient is unable to assist with the lift, patient handling equipment is expected to be used, with at least one other associate, when available. Unique patient lifting/movement situations will be assessed on a case-by-case basis.

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.