Contessa offers a unique opportunity for individuals interested in being part of an organization that is leading the country in redefining the way care is provided to patients. Contessa’s Home Recovery Care model brings all the essential elements of inpatient care to the comfort and convenience of a patient’s home. The model enables provider organizations and health plans to deliver high-quality, safe and affordable care to patients with non-life-threatening conditions. At Contessa, you will have the opportunity to make a direct impact on the lives of patients and be at the forefront of shaping a pioneering space in the health care industry.
As a Recovery Care Coordinator (RCC), you will be at the forefront of Contessa’s highly innovative care model that allows patients who are clinically appropriate to have the option to receive acute care in the comfort of their own homes in lieu of an inpatient setting. As a Recovery Care Coordinator, you will be fully integrated into the clinical teams at our health system partner working directly with patients and the clinical teams on the floor of the hospital and telephonically from an office setting as well as potentially providing nursing care visits with the patients in their homes.
This role offers the unique opportunity to work directly with the patient and their providers for a full 30 days. This allows you, the RCC, to not only coordinate their recovery from the acute illness but also develop the deep relationships with patients needed to successfully engage them with the resources they’ll need to improve their health and quality of life.
As a Recovery Care Coordinator, you will leverage Contessa’s proprietary workflow platform, advanced telehealth technology, and our interdisciplinary network of doctors, nurses, social workers, and ancillary providers to improve the health and well-being of patients and ease the burden on caretakers.
• Identifies potential patients for program inclusion through rapid recognition of clinical determinants that indicate patient eligibility.
• Possesses clinical knowledge, experience, and acumen to identify, present, and discuss potential HRC patients to providers for program inclusion. These direct discussions usually include ED providers and hospitalists but may span across multiple subspecialties.
• Facilitates communication and coordination between all members of the care team to coordinate admissions.
• Coordinates referrals and appropriate resources to assist patient and/or caregiver in continuation of care in the outpatient setting.
• Initiate the “start of care” process with the patient both in the hospital setting and in the patient’s home by conducting a complete skilled nursing assessment, psychosocial assessment, home environment evaluation, and patient onboarding activities.
• Generates operational quality reports and presents updates on to our partners’ physicians and nurses.
• Maintains all required documentation in all interactions with our health systems’ patients and the care team.
• Follows clinical and operational workflows.
• Provides prompt, courteous, and excellent service to internal and external customers.
• Interacts with the patient and the multidisciplinary team to coordinate the services ordered by our partners’ physicians. Communicates to the appropriate providers about any barriers to the patients’ fulfillment of our partner provider’s Care Plan.
• Communicates discharge information to other clinical departments or members of the Care Team.
• Watches for trends and hurdles involved in health care system and incorporates operational solutions for system challenges, including patient, family and physician responses into an evolving process and model that increases quality and satisfaction– patient or physician.
• Builds and maintains collaborative professional working relationships with physicians, Medical Directors, clinicians, and community at large to develop and implement a successful cross-continuum care management process
• Works with partner physicians to educate patients on the Home Recovery Care model; provides education regarding use of the telehealth system and processes.
• Confirm admission health and home assessment data collection accuracy to ensure the home environment is safe.
• Ensures that patients have access to appropriate services to meet their provider-directed care plan needs.
• Monitors the care that the patient receives and brings it to the attention of a provider.
• Assists as needed in recruiting, client and community outreach and critical incident/incident/complaint management.
• Education: ASN – Associate of Science in Nursing, BSN preferred
• Licensure: Current, active RN licensure in good standing
• Experience: 3-5 years of recent acute nursing experience (ED and ICU strongly preferred). Possess a high level of competence in recognition of clinical implications of diagnostic information and a general knowledge of clinical standards and outcome measurement.
• BLS required
• Work Schedule: Monday through Thursday 11-7 and Friday 1-9 rotating weekend on call
• Health: Able to pass required drug screen and communicable disease screenings
• Background: Able to pass detailed criminal background check according to company policy
Qualifications (Desired but not required):
• Certification: Care Coordination and Transition Management (C.C.C.T.M)
• Comfort with engaging providers in intense work environments such as the ED.
• Comfort with using technology, learning new software applications, and managing multiple documentation and communication streams simultaneously.