Operating Room RN - First Assist Only Skills Checklist (RNFA)

Name

First Last

Email

Recruiter's Name*

AGE OF PATIENTS CARED FOR

Newborn/Neonate (birth to 30 days)*

0
1
2
3

Infant (31 days to 12 months)*

0
1
2
3

Toddler/Preschool (13 months to 5 years)*

0
1
2
3

School Age Child/adolescent (6 years to 18 years)*

0
1
2
3

Young Adults/Middle Adult (19 years to 64 years)*

0
1
2
3

Older Adults/Elderly (65+ years)*

0
1
2
3

SKILLED ENVIRONMENTS

Acute Care/ Hospital*

0
1
2
3

Managed Care*

0
1
2
3

SNF/ Long Term Care*

0
1
2
3

Home Health*

0
1
2
3

Outpatient*

0
1
2
3

GENERAL CASE MANAGEMENT

Written Communication Skills*

0
1
2
3

Verbal Communication Skills*

0
1
2
3

Basic Negotiation Skills*

0
1
2
3

Job Related Computer Skills*

0
1
2
3

Ability to Prioritize*

0
1
2
3

Knowledge of Community Health Care and Vocational Services*

0
1
2
3

Ability to Properly Maintain Records*

0
1
2
3

Knowledge of Medical Billing Procedures*

0
1
2
3

Ability to Work Effectively in All Situations*

0
1
2
3

Ability to Assess, Plan, Implement and Evaluate Individual Patient Care Programs and Treatment Plans*

0
1
2
3

Ability to Gather Data, Compile Information and Prepare Reports*

0
1
2
3

Ensure Outcomes are Met within an Appropriate Length of Stay*

0
1
2
3

Coordinate and Monitor Services, Including Comprehensive Tracking of Client Activities in Relation to Care Plan*

0
1
2
3

Conduct Medication and Mental Status Assessment and Determine Required Level and Frequency of Service*

0
1
2
3

Document All Client Encounters*

0
1
2
3

Complete and Submit Billing Documentation as Appropriate*

0
1
2
3

Identify and Provide Emergency Crisis Services as Necessary*

0
1
2
3

Make Immediate Clinical Assessments and Respond According to Accepted Crisis Intervention Methods and Techniques; Coordinate Other Services as Appropriate*

0
1
2
3

Ability to Develop and Implement Action Plans for Health Centers to Improve Performance*

0
1
2
3

Knowledge of "Do Not Use Abbreviations"*

0
1
2
3

Knowledge of current Joint Commission National Patient Safety Goals*

0
1
2
3

IV Pumps

Other IV Pumps

EXPERIENCE

Disability Review*

0
1
2
3

Long Term/ Short Term Disability Case Management*

0
1
2
3

Workers Compensation Case Management*

0
1
2
3

Telephonic Case Management*

0
1
2
3

Pre Certification/ Pre-Admission Certification*

0
1
2
3

Catastrophic Case Management*

0
1
2
3

Concurrent Review*

0
1
2
3

Continued Stay Review*

0
1
2
3

Retrospective Review*

0
1
2
3

MCM - Medical Case Management*

0
1
2
3

ISD-A Interqual Criteria for Hospital Admissions*

0
1
2
3

Intensity of Service - Diagnosis & Therapeutic Services*

0
1
2
3

Discharge Screens - Specific Indicators of Patients Ability*

0
1
2
3

Appropriateness of Care - Special Diagnosis and Therapeutic Procedures*

0
1
2
3

DRG - Diagnosis Related Grouping (exempt & non exempt states)*

0
1
2
3

ICD - 9- CM*

0
1
2
3

Milliman and Robertson Criteria*

0
1
2
3

PPR - Prospective Procedure Review*

0
1
2
3

PA - Physician Advisor*

0
1
2
3

Prior Authorization*

0
1
2
3

Utilization Review*

0
1
2
3

Utilization Management*

0
1
2
3

EMR Systems

Other EMR Systems

Your Initials*

I hereby certify that all information contained on this application is true and complete.

Today's Date*

(212) 216-0007

Operating Room RN – First Assist Only Skills Checklist (RNFA)

Instructions:

Case Manager RN Skills Checklist

AGE OF PATIENTS CARED FOR

SKILLED ENVIRONMENTS

GENERAL CASE MANAGEMENT

EXPERIENCE